International Journal of Cancer Management
Volume:8 Issue: 2, Apr 2015

Health scientists are constantly trying to support people by diagnosing, managing the diseases, and improving health in all possible dimensions. Attention has been drawn to all aspects of health including biological, psychological, social and spiritual. The problem may lay in behavior, clinical issues, organ cites, genome and epigenome. Thus it falls on us, the medical society, to figure out when and where we are to follow signs and symptoms in clinic, in the organs or in the molecular disturbances. What clinicians are looking for are laboratory findings, imaging results, even genetic and epigenetic suppression and over expression. It is known as a fact that any event of disease carries changes ranging from clinic to genome, but the challenging issue lies in managing these signs and symptoms to better help people. The responsibility of health problem management rests with clinicians whose leadership contributes to a great extent to solving the problem. The leaders’ understanding of the disruptions within a conceptual framework would guide all measures to achieve the primary goal: health. Leadership is different from management in that the manager’s understanding will guide the process appropriately yet not correctly. Clinicians as leaders can have a fundamental insight on different aspects of the event in behaviors, clinic, organs, and genome disturbances. Thus they may use the lab findings or imaging results but not as a technician in this regard rather as a leader when leaders engage in treatment of a disease, they can make informed decisions due to their comprehensive understanding of the complexities of human being.Sometimes the managing a single disease in different people is different and it is the clinician’s judgment. Clinicians and leaders’ measures should be supported by all other biological evidences including lab tests or imaging findings. The problem is everywhere but the decision making is in the mind of clinician. This is how improvements in the history of medicine were initiated and so will be in the future.

Breast cancer is the most common cancer in women that as a sudden event has profound effects on all aspects of patients’ lives. Psychosocial interventions may play important roles in reducing anxiety and depression among breast-cancer survivors. Therefore, group training based on acceptance and commitment therapy may help women to cope better with their condition, and decrease their anxiety and depression. In a quasi-experimental study, 30 patients with breast cancer were selected by convenience sampling method and randomly assigned to 2 experimental and control groups. The experimental group attended acceptance and commitment training classes for 8 weeks continuously (each class lasting 90 minutes). Participants in both the experimental and control groups completed Beck Anxiety Inventory (BAI) and Beck Depression Inventory (BHI-II) as a pretest and posttest. Analysis of Covariance was used as the statistical method. In acceptance and commitment group training, anxiety and depression significantly decreased (p<0/05). These changes were not observed in the control group. The results showed that group training based on acceptance and commitment therapy is an effective method in reducing anxiety and depression. Hence psychological interventions can be used to reduce psychological difficulties of women with breast cancer.

Guidelines have produced and used in complex environment of health care system with its ethical, economical, legal and other aspects; that should be taken into account in any country. Modifying the format and content of guidelines might facilitate their usage and lead to improved quality of care and cost containment. We have produced this tool for explained above purpose. A coordinating national team has settled at the office of minster of health and medical education, supported by a guideline review committee. An innovative and appropriate approach for adapting national health guidelines has consisted of eight steps, have defined For preparing the draft of each guideline a technical team which, including main author, her/his co-workers have nominated. The authors of each topic have systematically searched databases of the proposed Twenty-two International Sites, and then have selected at least five sources of them that were more relevant. The final recommendations have proposed by agreement of technical team and Guideline Review Committee. In less than 5 months, more than 500 authors in whole country have selected to prepare guidelines and, approximately 150 guidelines have provided in three volumes of the published and distributed book. Each guideline had a national ID number, constant forever; all topics should be reviewed every 3-5 years. National health guideline(s) would be essential means for policy making in health system and increased the cost containment and quality of care.

Chemotherapy- induced nausea and vomiting (CINV) occur frequently causing problems with an unacceptably high incidence that significantly affect patients'' daily functioning and health-related quality of life. The present study was aimed to compare acute CINV for granisetron as 5-HT3 receptor antagonist and metoclopramide in the patients receiving chemotherapeutic regimens including cyclophosphamide and adriamycin. An attempt is made to examine whether it is possible to successfully replace granisetron with metoclopramide in control of acute CINV. A total of 137 patients with breast cancer (78.8%) and lymphoma (17.5%) from two oncology departments in the first course of chemotherapy were enrolled. They received granisetron 3mg/IV and dexamethasone 8mg for the first referring and in the second referring metoclopramid 30mg/IV and dexamethasone 8mg/IV thirty minutes before chemotherapy and metoclopramide 20mg/IV during chemotherapy. The patients recorded the incidence of chemotherapy induced nausea and vomiting (CINV) and other side effects including headache, extra pyramidal manifestations and delayed nausea. Median age of studied patients was 49±15 year. The patients who received granisetron and dexamethasone had less acute nausea (during the first 24 hours after chemotherapy) than those who received metoclopramide. Also our study showed that controlled CINV episodes in patients who received CMF regimen were better than the regimen including adriamycin (CAF, CHOP) into both granisetron (p=0.06) and metoclopramid (p=0.04). The most common adverse event related to these drugs was extra pyramidal manifestations for 16 and 10 patients who had received granisetron and metoclopramide respectively. While the number of the patients who had sever delayed CINV (2-7 days after chemotherapy) episodes with granisetron (7 cases) was lower than those who took metoclopramide drug (14 cases). The number of patients who experienced extrapyramidal manifestations in metoclopramide group was lower than granisetron group. There were not any significant clinically serious adverse events in any patients undergoing chemotherapy due to cancer. Thus, the safety profiles of granisetron and metoclopramide were comparable in this study. The patients who were treated with cyclophosphamide, and adriamycin, the efficacy of dexamethasone and metoclopramide in controlling acute nausea and vomiting nearly equaled to those of granisetron. Thus the present study supports the use of metoclopramide due to its lower cost and nearly the same efficacy and safety compared to granisetron in CMF regimen.

Considering the poor survival rate of patients with esophageal cancers, mainly due to the disease effects and surgical co morbidities, we have aimed to introduce a new method of Transhiatal Esophagectomy (THE) without mediastinal manipulation for lower third esophageal and cardial cancers. It has suggested that using this technique would decrease mentioned complications. In this prospective study, patients with esophageal cancer who referred for surgical treatment have enrolled and undergone to new method of THE, without mediastinal manipulation. Pre and post-operative morbidities as well as the duration of procedure, duration of hospital and ICU stay have recorded. All patients have followed up or 4-40 months. In this study 53 patients with mean age of 55.2+/-10.3 years have undergone esophagectomy, and then in 50 of them the new method has performed. Median operative time and volume of blood loss was 120 minutes and 130 ml, respectively. Median duration of hospital and ICU stay was 7 and 1 day, respectively. There were no Pre-operative mortalities, arrhythmia, hemodynamic instability and mediastinal vessels injury. The most common co morbidities have related to our new method were mediastinal pleura injury, anastomotic leaks and anastomotic narrowing with 20%, 16% and 10% reported rate, respectively. The findings of current study have indicated that transhiatal esophagectomy without mediastinal manipulation, has represented a safe and effective method for treatment of lower third esophageal and cardial cancers due to its potential advantages of decreased blood loss, being a less traumatic procedure, minimal cardiopulmonary complications and low rate of hospital mortality.

Chronic lymphocytic leukemia (CLL) has been the most common type of leukemia in adults worldwide, and then more common in the elderly, markedly more common in patients over the age of 65 years. Seventy patients with CLL have referred to Clinic of Hematology-Oncology, Kermanshah, Iran, between Jan 2000 and Jun 2014. We have analyzed age, sex, survival, kind of chemotherapy and type of response in all of the patients with chronic lymphocytic leukemia. Survival curves of complete response patients have compared with partial response, by log-rank test using the Prism 5 GraphPad Software for the five-year period with two years follow up. The mean age of patients was 61.57±8.88 years that 55.7% were males. Between the 70 patients, 40 patients (57.1%) have started treatment with chlorambucil and 30 patients (42.9%) with chlorambucil plus prednisolone. Among the forty patients that have treated with chlorambucil, overall response rate was 95% that 9 patients (22.5%) had complete response. Among the 30 patients that have treated with chlorambucil plus prednisolone, overall response rate was 96%, that 9 patients (30%) had complete response after six months of treatment. The mean of five-year overall survival for treated patients with chlorambucil and chlorambucil plus prednisolone in the first-line of therapy was 38.5 and 40.5 months, respectively. Combination of prednisolon to chlorambucil has increased survival rate in the patients more than mono-therapy with chlorambucil and also the complete response rate to chlorambucil in West of Iran was better than other areas of world.

Potential association of leptin (LEP) gene polymorphisms has been suggested in the processes leading to breast cancer initiation and progression. We investigated whether genetic variations in the LEP -2548G/A gene are associated with risk of breast cancer. This case-control study consisted of 100 breast cancer cases and 100 control subjects without breast cancer that matched for age and body mass index (BMI). Genotyping of LEP -2548G/A polymorphism was performed by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) assay. Serum leptin level was determined by ELISA in all study subjects. The genotype distributions (AA, AG, and GG) were 36, 55, and 9% in breast cancer cases and 52, 45, and 3% in control group, respectively. The frequency of LEP -2548 GG genotype was significantly elevated in breast cancer cases as compared to controls (χ2=6.90, p=0.032). Similar difference was also found in allele frequencies between two groups (χ2=5.65, p=0.017). A markedly increase risk of breast cancer was associated with the LEP -2548GG genotype when compared to the LEP -2548 AA genotype (OR=4.33, 95% CI=1.09-17.22). In addition, postmenopausal women who bear at least one LEP -2548 G allele were at a markedly increased risk of breast cancer after adjusting for age and BMI confounders (OR=12.24, 95% CI=1.13-131.73). The LEP -2548 G/A polymorphism is associated with markedly increased risk of breast cancer especially in postmenopausal Ahvazian women and supported the hypothesis that leptin is involved in breast cancer.

TNFα cytokine family in the body plays divers’ roles in the cellular events such as cell proliferation, differentiation, necrosis, septic shock and apoptosis. In response to TNF therapy, several cell signaling pathways activated in cells which in different manners can lead to apoptosis or necrosis. However induction of apoptosis is depended on one of its important members, TRAIL and its receptors that will be followed by apoptosis activity. Tumor necrosis factor-related apoptosis-inducing ligand (TRAIL) and especially the DR5, is generating considerable interests as a possible anticancer therapeutic agent because of its selective activation in apoptosis of this receptor as a superior affinity to ligands. The study was performed in invitro assay and the anticancer effects of the produced antibodies were assumed by MTT and flowcytometric methods. In the first step for immunization of the hens, three selective small peptides from extracellular domain of DR5 which were chemically synthesized, injected to hens and after the proper immunization of them, IgYs were extracted from the egg yolk. After assumption of specificity of the purified IgYs against the whole DR5 protein, they were performed in MTT assay and flowcytometric colorimeter. After confirmation of synthesized peptides they were injected to hens with Fround`s complete adjuvant. With completing the immunization procedure the specificity of purified IgYs were confirmed by ELISA. The antibodies were significantly killed the MCF7 breast cancer cells, but had divers affect (proliferative) on normal hepatocyte cells. Additionally, significantly they induced apoptosis on the cancerous cells in contrast to control cells. The results clearly demonstrated that the produced IgYs with reduced cost and time managing could remarkably use as an effective anticancer drug.

The aim of this study was to evaluate computer aided diagnosis (CAD) system with texture analysis (TA) to improve radiologists'' accuracy in identification of thyroid nodules as malignant or benign. A total of 70 cases (26 benign and 44 malignant) were analyzed in this study. We extracted up to 270 statistical texture features as a descriptor for each selected region of interests (ROIs) in three normalization schemes (default, 3s and 1%-99%). Then features by the lowest probability of classification error and average correlation coefficients (POE+ACC), and Fisher coefficient (Fisher) eliminated to 10 best and most effective features. These features were analyzed under standard and nonstandard states. For TA of the thyroid nodules, Principle Component Analysis (PCA), Linear Discriminant Analysis (LDA) and Non-Linear Discriminant Analysis (NDA) were applied. First Nearest-Neighbour (1-NN) classifier was performed for the features resulting from PCA and LDA. NDA features were classified by artificial neural network (A-NN). Receiver operating characteristic (ROC) curve analysis was used for examining the performance of TA methods. The best results were driven in 1-99% normalization with features extracted by POE+ACC algorithm and analyzed by NDA with the area under the ROC curve (Az) of 0.9722 which correspond to sensitivity of 94.45%, specificity of 100%, and accuracy of 97.14%. Our results indicate that TA is a reliable method, can provide useful information help radiologist in detection and classification of benign and malignant thyroid nodules.

Acute Myelogenous Leukemia (AML) is an aggressive hematologic malignancy that cause by abnormal proliferation and accumulation of hematopoietic progenitor cells. A 37-year-old woman referred to oncologic clinic with a self-detected mass and pain in her left breast. The stage of tumor was ΙΙΙA. She was treated with the combination of anthracycline and cyclophosphamide for four courses, followed by four courses of paclitaxel with trastuzumab for one year. After 18 months of the first treatment for breast cancer, her bone marrow biopsy was compatible with AML-M2.Here, we are reporting a young woman case with breast cancer that developed AML malignancy during short interval of therapy.

Among the group of small round cell tumors of kidney Ewing’s sarcoma/PNET is a very rare entity which has aggressive clinical course. We report a case of renal mass in 24 years old male which was histologically diagnosed as small round cell tumor of kidney. Arrangement of the malignant cell along with vascular network in a filigree pattern was suspicious for a diagnosis of Ewing’s sarcoma/PNET which was confirmed by positivity of CD 99 immunohistochemically. Thus careful histological observation and immunohistochemical stains can give the proper diagnosis of primary Ewing’s sarcoma/PNET thus removing the diagnostic dilemma in the group of small round cell tumors.