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Publication
Journal: Canadian family physician Medecin de famille canadien
November/14/2019
Abstract
To review and summarize the recently developed Canadian Association of Gastroenterology screening recommendations for patients with a family history of colorectal cancer (CRC) or adenoma from a family medicine perspective.

QUALITY OF EVIDENCE
A systematic review and meta-analysis was performed to synthesize knowledge regarding family history and CRC. The Cochrane Central Register of Controlled Trials, MEDLINE, and EMBASE were searched with the following MeSH terms: colorectal cancers or neoplasms, screen or screening or surveillance, and family or family history. Known hereditary syndromes were excluded. The Grading of Recommendations Assessment, Development and Evaluation methodology was used to establish certainty in reviewed evidence. Most recommendations are conditional recommendations with very low-quality evidence.

Individuals who have 1 first-degree relative (FDR) with CRC or an advanced adenoma diagnosed at any age are recommended to undergo colonoscopy every 5 to 10 years starting at age 40 to 50 years or 10 years younger than the age at diagnosis of the FDR, although fecal immunochemical testing at an interval of every 1 to 2 years can be used. Individuals with FDRs with non-advanced adenomas or a history of CRC in second-degree relatives should be screened according to average-risk guidelines. Lifestyle modification can statistically significantly decrease risk of CRC and should be considered in all patients.These guidelines acknowledge the many factors that can increase an individual's risk of developing CRC and allow for judgment to be employed depending on the clinical scenario. Lifestyle advice already given to patients for weight, blood pressure, and heart disease management will reduce the risk of CRC if implemented, and this combined with more targeted screening for higher-risk individuals will hopefully be successful in decreasing CRC mortality in Canada.
Publication
Journal: The Journal of laryngology and otology
October/31/2019
Abstract
To analyse the incidence of second primary lung cancer following treatment for laryngeal cancer and to identify risk factors for its development.Retrospective case series.The five-year actuarial incidence of second primary lung cancer was 8 per cent (1.6 per cent per year). This was associated with a very poor median survival of seven months following diagnosis. Supraglottic tumours were associated with an increased risk of second primary lung cancer compared to glottic tumours in both univariate (hazard ratio = 4.32, p = 0.005) and multivariate analyses (hazard ratio = 4.14, p = 0.03).Second primary lung cancer occurs at a rate of 1.6 per cent per year following a diagnosis of laryngeal cancer, and this is associated in a statistically significant manner with supraglottic primary tumour. The recent National Lung Cancer Screening Trial suggests a survival advantage of 20 per cent at five years with annual screening using low-dose computed tomography scanning of the chest in a comparable cohort to ours. These findings have the potential to inform post-treatment surveillance protocols in the future.
Publication
Journal: Echocardiography (Mount Kisco, N.Y.)
October/26/2019
Abstract
Primary cardiac neoplasms are rare, and the pericardial schwannoma has an even lower occurrence. We report a case of pericardial schwannoma in China, which is the eighth reported case adding to the existing literature on pericardial schwannoma, and this is the first case reported complicated with massive pericardial effusion. Pericardial schwannomas are usually benign, but they can sometimes have a malignant tendency and cause life-threatening complications. Thus, it should be managed aggressively and completely resected.
Publication
Journal: Nature communications
October/25/2019
Abstract
Uterine leiomyomata (UL) are the most common neoplasms of the female reproductive tract and primary cause for hysterectomy, leading to considerable morbidity and high economic burden. Here we conduct a GWAS meta-analysis in 35,474 cases and 267,505 female controls of European ancestry, identifying eight novel genome-wide significant (P < 5 × 10-8) loci, in addition to confirming 21 previously reported loci, including multiple independent signals at 10 loci. Phenotypic stratification of UL by heavy menstrual bleeding in 3409 cases and 199,171 female controls reveals genome-wide significant associations at three of the 29 UL loci: 5p15.33 (TERT), 5q35.2 (FGFR4) and 11q22.3 (ATM). Four loci identified in the meta-analysis are also associated with endometriosis risk; an epidemiological meta-analysis across 402,868 women suggests at least a doubling of risk for UL diagnosis among those with a history of endometriosis. These findings increase our understanding of genetic contribution and biology underlying UL development, and suggest overlapping genetic origins with endometriosis.
Publication
Journal: The Korean journal of gastroenterology = Taehan Sohwagi Hakhoe chi
October/25/2019
Abstract
Advances in diagnosis and therapeutic technologies have brought increased life expectancy for most cancers, but paradoxically it also has increased the risk of second primary malignancies. Cancer survivors have a higher risk of developing cancer than the general population. This suggests that more studies are needed to develop screen and management programs for cancer survivors, especially patients with gastrointestinal cancers, which are the most common cancers in Korea.
Authors
Publication
Journal: Problemy endokrinologii
October/19/2019
Abstract
Thyroid lesions after radiation and chemotherapy include thyroid tumors and thyroiditis, which occur in violation of its function, as well as secondary hypothyroidism due to damage to the pituitary region. Hereinafter, we will use the term 'chemoradiotherapy', since in the treatment of malignant neoplasms, schemes are most often used that include both radiation exposure and drug treatment, and it is almost impossible to single out the influence of each of these components individually.
Publication
Journal: Annals of clinical and laboratory science
October/15/2019
Abstract
More than 100 cases harboring both myeloproliferative neoplasms (MPN) and chronic lymphocytic leukaemia (CLL) have been reported, suggesting that the two diseases can coexist in one patient. However, the mechanism by which this phenomenon is caused remains unclear. In this study, one patient with polycythemia vera (PV) and CLL is examined. Identifications of the JAK2V617F and P53H179L/ P53R209fs mutations were obtained via targeted next generation sequencing. Furthermore, B lymphocytes and neutrophils were separated from peripheral blood. This led to the discovery that JAK2V617F occurs in neutrophil's compartment, with P53 mutations emerging in B lymphocytes. These results indicate that PV and CLL are independent clonal diseases in this case, rather than phenotypes derived from one clone.
Publication
Journal: Turkish neurosurgery
October/14/2019
Abstract
We aimed in this study sharing our inferences about this topic with the whole health community.Turkish National Cancer Statistics, statistics of Turkey in GLOBOCAN 2018 and worldwide statistics country-by-country in GLOBOCAN 2018 was compared to reach a summary on this topic.CNS tumors are 10th in cancers in men with 5.2 for per 100.000. Also, in women group, CNS tumors' rate is 4.1 for per 100.000 and take the 9th place of mostly seen first ten neoplasms. In general, the incidence of CNS cancers in women in our country is less than men as in the whole World. Turkish data between the years of 2010-2014 has shown that there is no significant difference for both sexes.Although CNS cancers do not have high incidence rates, they have important mortality rates and, they consist of one of a serious cause of death. Increase in the lifetime, exposure to environmental factors for the longer time, increasing usage of radioactive materials in our lives, easier access to healthcare systems and developing diagnosing possibilities may rise the incidence rates on CNS in the future. On the other hand, developing treatment modalities and posttreatmental care strategies may reduce the mortality in these group of the patient despite the high incidence .
Publication
Journal: Journal of medical ultrasonics (2001)
October/12/2019
Abstract
Endoscopic ultrasonography (EUS) is a modality with high spatial resolution that enables comprehensive observation of the entire pancreas and plays an important role in the diagnosis of pancreatic lesions. Recent advances in diagnostic imaging methods such as ultrasound, computed tomography, and magnetic resonance imaging have increased the incidental detection of pancreatic cystic lesions (PCLs). EUS has been recognized as an essential diagnostic method for the detection and evaluation of PCLs. EUS has two important roles: as a detailed (high-resolution) imaging diagnostic method and as an approach for collecting cyst fluid content by EUS-guided fine needle aspiration for pathological diagnosis or biomarker evaluation. Furthermore, in recent years, the usefulness of contrast-enhanced EUS for the differential diagnosis of PCLs or evaluation of grade of malignancy, and a novel imaging technique called needle-based confocal laser endomicroscopy to observe intraductal structures through a needle, has been reported. An understanding of the morphological characteristics of PCLs depicted by ultrasound imaging and of the benefits and limitations of EUS diagnosis in daily practice is needed.
Publication
Journal: Revista espanola de salud publica
October/9/2019
Abstract
Implementation of Shared Decision Making (SDM) in oncology is limited. The objective of the study was to determine the extent of physicians' awareness of Shared Decision Making (SDM) in their treatment of cancer patients, the usefulness that they assign to SDM, the role they play, their assessment of SDM, and perceptions of the main barriers and facilitators to its use.A questionnaire was completed by medical oncologists, radiation oncologists and general surgeons working in Andalusia (Spain). Sociodemographic, clinical-care and aspects of SDM variables were collected. SDM was evaluated using the SDM-Q-Doc questionnaire. Non-parametric contrasts were used to determine the possible differences between medical specialties.The questionnaire was sent to 351 physicians. The response rate was 37.04%, 63 women and 67 men, with an average age of 45.6 years and 18.04 years' experience. Of these, 33.08% were medical oncologists, 34.61% radiation oncologists and 29.23% general surgeons. A total of 82.3% stated they had received no training in SDM, whereas 33.8% said they knew a lot about SDM and applied it in practice; 80% considered it to be very useful. In addition, 60% of respondents said they were mainly the ones who made the decisions on treatment. An evaluation of SDM on the SDM-Q-Doc scale showed that all the specialities scored more than 80/100. The main barriers to applying SDM were the difficulty patients experienced in understanding what they needed to know, the lack of decision aids and time.Some 82% of physicians have no training in SDM and 66% don´t use it in practice, with decisions on treatment taken mainly by the physicians themselves. Strategies to increase training in SDM and to implement it into clinical practice are important.
Publication
Journal: BMJ supportive & palliative care
October/4/2019
Abstract
Evidence of the role of palliative care to reduce financial hardship and to support wellbeing in low/middle-income countries (LMIC) is growing, though standardised tools to capture relevant economic data are limited. We describe the development of the Patient-and-Carer Cancer Cost Survey (PaCCCt survey) which can be used to gather data on healthcare use and out-of-pocket expenditure (OOPE) in households affected by cancer in LMIC.To identify relevant content qualitative data were gathered using Photovoice to detail concepts of wellbeing and cost areas of importance in households receiving palliative care in Blantyre, Malawi. Existing approaches and tools used to capture OOPE were mapped through a review of the literature. The WHO tuberculosis patient cost survey was chosen for adaptation. Face and content validity of a zero-draft of the PaCCCt survey were developed through review by healthcare professionals and a national stakeholder group. The final survey was translated into local language (Chichewa) and piloted.The PaCCCt survey is a tablet-based, third-party administered survey recording healthcare service utilisation and related direct and indirect costs. Coping strategies (loans and dissaving and so on), funeral costs and wellbeing at household level are included. Completion time is <30 min.The PaCCCt survey can be used as part of economic evaluations in populations in need of palliative care in LMIC. Such evidence can support calls for the inclusion of palliative care within Universal Health Coverage which requires end-user protection from financial hardship.
Publication
Journal: Veterinary radiology & ultrasound : the official journal of the American College of Veterinary Radiology and the International Veterinary Radiology Association
October/1/2019
Abstract
In order to identify CT signs that could be used to distinguish cranial mediastinal lymphoma and thymic epithelial neoplasia, a retrospective case-control study was done. Associations between CT signs and diagnosis were tested using binary logistic regression and results expressed as odds ratio and 95% confidence interval. Sixty-two dogs that had thoracic CT and confirmed diagnosis of lymphoma (n = 33) or thymic neoplasia (n = 29) were sampled. Thymic neoplasms included 24 thymomas and five thymic carcinomas. Dogs with thymic epithelial neoplasia were significantly older than dogs with lymphoma (median age 8.6 years versus 6.0 years, P = .007), but there were no significant differences in prevalence of clinical signs. Diagnosis of thymic epithelial neoplasia was associated with heterogeneous attenuation in pre- (odds ratio 23.3, 95% confidence interval, 4.5-121.1) and post-contrast (odds ratio 30.7, 95% confidence interval, 3.6-265.0) images. Conversely, envelopment of the cranial vena cava by the mass was less likely with thymic epithelial neoplasia than lymphoma (odds ratio 0.07, 95% confidence interval, 0.007-0.66). Greater standard deviation of Hounsfield unit values in post-contrast images was associated with thymic epithelial neoplasia (P = .005). Based on ROC analysis, SD > 17HU of the mass in post-contrast images had a sensitivity of 72% and specificity of 79% for thymic epithelial neoplasia. There were no significant differences in morphology, prevalence of calcification, mediastinal lymphadenopathy, cranial vena cava invasion, collateral vessels, or pleural fluid associated with these tumors. Thymic epithelial neoplasms tended to occur in older dogs and were heterogeneous in CT images, whereas mediastinal lymphoma was more homogeneous and more likely to envelop the cranial vena cava.
Publication
Journal: The breast journal
September/28/2019
Publication
Journal: Haematologica
September/27/2019
Abstract
Publication
Journal: Neuroendocrinology
September/26/2019
Abstract
In gastroenteropancreatic (GEP) high-grade neuroendocrine neoplasms (H-NENs), Ki-67 threshold of 55%, instead of 20%, defines three prognosis subclasses: neuroendocrine tumor (NET) G3, neuroendocrine carcinoma (NEC) <55% and NEC ≥55%. We investigated whether the molecular profiling of H-NENs differ among these sub-categories and evaluated potential therapeutic targets, including PD-L1.In consecutive GEP-NEN patients we evaluated: i) 55% threshold for Ki-67 labelling index for further stratifying NEC, ii) immunoreactivity and gene mutations by immunohistochemistry and Targeted Next Generation Sequencing (T-NGS).15 NETs G3 and 39 NECs were identified. Ki-67 labelling index was <55% in 9 NECs and ≥55% in 30 NECs. Gene mutations by NGS (TP53, 32.9%, KRAS, 5.5%, BRAF, 4.1%) were detected in 46.6% NENs in more details significantly enriched in NEC ≥55% (76.7%) than NEC <55% (55.6%) or in NET (20.0%). PD-L1 was observed in NEC ≥55% (36.7%; p=0.03). Median OS was 4.3 years in NET G3, 1.8 years in NEC <55% and 0.7 years in NEC ≥55% (p<0.0001); it was 2.3 years with NGS Wild-Type, 0.7 years with ≥1 mutation (p<0.0001), 0.8 years in PD-L1 positive patients and 1.7 years in PD-L1 negative subjects (p=0.0004). At multivariable analysis, only our classification reached statistical significance (NEC <55% vs. NET G3, HR 14.1, 95% CI 2.2-89.8, p=0.005; NEC ≥55% vs. NET G3, HR 25.8, 95% CI 3.9-169, p=0.0007).These findings identify NEC ≥55% as a biologically and prognostically distinct subtype besides they pave the way for personalized treatment.
Publication
Journal: The Veterinary record
September/26/2019
Abstract
Neoplasia has historically been regarded as an unusual occurrence in reptiles. The aim of the present study was to evaluate the prevalence of neoplasms in routine diagnostic samples submitted to a specialist exotic animal laboratory.Over a 10-year period, 690 lizard samples were submitted for histopathological or cytopathological examination by Royal College of Veterinary Surgeons specialists in Veterinary Pathology (Zoo and Wildlife). Records were reviewed retrospectively and non-neoplastic diagnoses excluded from further analysis.158 neoplasms were diagnosed in 149 lizards, with 22.9% of submissions resulting in a diagnosis of neoplasia. The skin was the most commonly affected organ, and squamous cell carcinomas were the most common neoplasms identified (17.7% of all neoplastic diagnoses).Bearded dragons and panther chameleons had a statistically significant higher proportion of neoplasia diagnosis than the lizard population as a whole, and geckos had a statistically significantly lower proportion.Several neoplasms identified in this study have not been previously reported in lizards, including a testicular Sertoli cell tumour, testicular granulosa cell tumour, splenic haemangiosarcoma, gastric adenocarcinoma and basal cell carcinoma.The results suggest that the prevalence of neoplasia in captive lizards may be higher than previously reported, and that there is variation in prevalence between different lizard species and families. It is unclear whether these differences relate to genetic or management factors.
Publication
Journal: Archives of pathology & laboratory medicine
September/26/2019
Abstract
Follicular nodules are the most common source of diagnostic difficulties in the practice of surgical pathology of the thyroid. This is due to a variety of factors, the most salient of which is the lack of well-defined criteria and evidence-based data for the diagnosis of these lesions.To discuss some of the assumptions that have been accrued over the years regarding the criteria by which we evaluate such lesions.The information presented herein is based on review of the literature and the author's personal experience.Thyroid nodules with a predominant follicular growth pattern span the range from benign lesions (hyperplastic nodules, adenomatoid nodules, follicular adenomas) to malignant neoplasms (follicular carcinoma, follicular variant of papillary carcinoma) with a host of intermediate or indeterminate lesions found in between. Advances in immunohistochemistry and molecular pathology have not yet provided a reliable way of separating the borderline or intermediate cases. Low-grade and intermediate or borderline follicular-patterned thyroid lesions are those most often prone to difficulties for interpretation. Newer and potential future approaches for the evaluation of these lesions are discussed.
Publication
Journal: Clinical advances in hematology & oncology : H&O
September/23/2019
Authors
Publication
Journal: The Journal of investigative dermatology
September/22/2019
Abstract
Recognition of transformed cells by the immune system can sometimes generate a rate-limiting "equilibrium phase," wherein tumor outgrowth is prevented without complete neoplasm elimination. Targeting premalignancies during this immune-controlled bottleneck is a promising strategy for rational cancer prevention. Thus far, immune equilibrium has been difficult to model in a traceable way and most immunoediting systems have been limited to mesenchymal tumor types. Here, we introduce a mouse model for fluorescent tracing of somatic, epithelial transformation. We demonstrate that transplantation can be used to prevent a confounding, artificial tolerance that affects autochthonous, inducible models. Using this system, we observe the expected dichotomy of outcomes: immune-deficient contexts permit rapid tumorigenesis, while initiated clones in immunocompetent mice undergo elimination or equilibrium. Strikingly, the equilibrium phase correlates with localization within hair follicles, which have been previously characterized as relatively immune-privileged sites. Given this, we posit that valleys in the immune surveillance landscape of a normal tissue can provide a cell-extrinsic alternative to the canonical, cell-intrinsic adaptations believed to establish the equilibrium phase. Our model is a prototype for tracing immunoediting in vivo and could serve as a novel screening platform for therapies targeted against immune-controlled premalignancies.
Publication
Journal: Revista espanola de patologia : publicacion oficial de la Sociedad Espanola de Anatomia Patologica y de la Sociedad Espanola de Citologia
September/18/2019
Abstract
Hepatic perivascular epithelioid cell tumors (PEComas) are uncommon mesenchymal neoplasms. PEComas concurrent with other hepatic lesions is a very rare occurrence, with only two previously reported cases. We report a primary hepatic PEComa associated with focal nodular hyperplasia in a patient with a previous history of cutaneous melanoma. Diagnostic imaging studies suggested a hepatic adenoma and the patient underwent a segmentectomy. The tumor was mainly composed of epithelioid cells, adipose tissue and smooth muscle fibers intermixed with blood vessels. The neoplastic cells were diffusely immunoreactive for HMB-45, Melan-A and smooth muscle actin, but not for Hepatocyte, S100, MITF or BRAF. Molecular studies were negative for BRAFV600 mutation. The final diagnosis was hepatic epithelioid angiomyolipoma/PEComa. The differential diagnosis of hepatic PEComa is discussed.
Publication
Journal: Journal of pathology and translational medicine
September/16/2019
Abstract
Gastrointestinal stromal tumors (GISTs) are the most frequent mesenchymal neoplasms of the gastrointestinal (GI) tract. Management of GIST patients is now based on the clinicopathological features and associated genetic changes. However, the detailed characteristics of GISTs and molecular genetic features have not yet been described in the Vietnamese population.155 patients with primary GISTs were identified who underwent surgery with primary curative intent between 2011 and 2014 at University Medical Center Ho Chi Minh City, Viet Nam. We evaluated clinicopathological features and immunochemical reactions for p53 and Ki-67 on these patients; additionally, molecular profiles of KIT genotyping were also analyzed in 100 cases.The largest portion of GISTs was classified as high risk (43.2%). Of 155 GISTs cases, 52 (33.5%) cases were positive with Ki-67 and 58 (37.4%) cases were positive with p53. The expression of Ki-67 and p53 was correlated with mitotic rate, tumor size tumor, risk assessment, and tumor stage. Out of 100 GISTs cases, the KIT mutation was found in 68% of which 62 (91,2%) were found in exon 11, 2 (2.9%) cases in exon 9 and 4 (5.8%) cases mutated in exon 17. No patient with a mutation was detected in exon 13 was identified. The KIT mutation did not correlate with any clinicopathological features.Expression of Ki-67 and p53 were associated with high risk tumor. The mutation on exon 11 was the most commonly found, followed by exon 17 and exon 9. The KIT mutation was not correlated with any recognized clinicopathological features.
Publication
Journal: Journal of medical ultrasonics (2001)
September/15/2019
Abstract
Pancreatic cystic lesions (PCLs) are incidental findings that are being increasingly identified because of recent advancements in abdominal imaging technologies. PCLs include different entities, with each of them having a peculiar biological behavior, and they range from benign to premalignant or malignant neoplasms. Therefore, accurate diagnosis is important to determine the best treatment strategy. As transabdominal ultrasonography (US) is noninvasive, inexpensive, and widely available, it is considered to be the most appropriate imaging modality for the initial evaluation of abdominal diseases, including PCLs, and for follow-up assessment. We present a review of the possibilities and limits of US in the diagnosis of PCLs, the technical development of US, and the ultrasonographic characteristics of PCLs.
Publication
Journal: Cancer epidemiology
September/14/2019
Abstract
Research on soft-tissue sarcoma (STS) and bone sarcoma (BS) is increasingly in the focus of physicians and pharmaceutical companies. Expanding knowledge has improved the management of sarcoma and possibly survival. Here we provide the first population-based data on time trends of incidence, mortality, and survival of STS and BS diagnosed in Switzerland between 1996 and 2015.We performed a retrospective registry study with data from the National Institute for Cancer Epidemiology and Registration (NICER) database in Switzerland between 1996 and 2015.We identified 5384 STS patients and 940 BS patients. The three most common STS subtypes were undifferentiated/unclassified sarcoma (22.3%), liposarcoma (20.6%) and leiomyosarcoma (20.6%). Chondrosarcoma, osteosarcoma and Ewing sarcoma represented 40.4%, 27.0% and 15.2% of the BS group, respectively. The age-standardized incidence and mortality rates in 2011-2015 were 4.43 and 1.42 per 100,000 person-years for STS, and 0.91 and 0.42 for BS. Age-standardized incidence of STS in males was significantly higher during 1996-2000 than during 2001-2015; however, mortality rates did not change significantly over time. Five-year relative survival (RS) for STS improved significantly from 56.4% (95%CI 52.9-59.7 for 1996-2001) to 61.6% (95%CI 58.6-64.4 for 2011-2015) (p = 0.025). No improvement in 5-year RS for BS could be observed (RS 1996-2000: 69.6%, 95%CI 61.2-76.6; RS 2011-2015: 73.1%, 95%CI 66.6-78.6; p = 0.479).Incidence rates of STS and BS have been stable since 2001. The longer RS in STS can be attributed to advances in sarcoma patient management.
Publication
Journal: Blood
September/13/2019
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