Angelika Copija

Clinical Significance and Prognostic Relevance of Microsatellite Instability in Sporadic Colorectal Cancer Patients

Microsatellite instability (MSI) is a marker of the replication error phenotype. It is caused by impaired DNA mismatch repair processes (MMR), resulting in ineffectiveness of the mechanisms responsible for the DNA replication precision and postreplicative DNA repair. MSI underlies the pathogenesis of 10%–20% of colorectal cancer (CRC) cases. The data about the potential value of MMR status as a predictive factor for 5-fluorouracil (FU)-based chemotherapy remain unclear. According to National Comprehensive Cancer Network updated guidelines, MSI testing is recommended for all patients with stage II CRC because patients with MSI-H (high-frequency MSI) tumour may have a good prognosis and obtain no benefit from 5-FU-based adjuvant chemotherapy. The significance of the MSI status as a predictive factor for patients with metastatic disease was not confirmed. The association between the MSI status and the efficacy of the therapy based on anti-programmed death-1 receptor inhibitors requires further studies.

Praktyczne zalecenia żywieniowe w trakcie chemioterapii u chorych na nowotwory przewodu pokarmowego

Stan odzywienia chorych na nowotwory przewodu pokarmowego ściśle związany jest ze stosowanym leczeniem przeciwnowotworowym i wystepowaniem niepoządanych objawow związanych z terapią. Najcześciej u chorych w trakcie chemioterapii stwierdza sie zaburzenia w odczuwaniu smaku i zapachu, biegunki, zaparcia stolca oraz nudności i wymioty, co moze powodowac niechec do jedzenia, w konsekwencji prowadzic do niedozywienia chorego. Szacuje sie, ze niedozywienie wystepuje u okolo 80% chorych z rakiem przelyku, 60% – z rakiem zolądka i 10-15% – z rakiem jelita grubego. Stosowanie indywidualnych zalecen zywieniowych ma na celu lagodzenie niepoządanych objawow terapii oraz poprawiac stan odzywienia. Opieka dietetyczna powinna byc wlączona do planu opieki chorego i stanowic jego integralną cześc. W oddzialach szpitalnych, w ktorych nie funkcjonuje zespol terapeutyczny obowiązek zaznajomienia chorych z zaleceniami zywieniowymi spoczywa glownie na personelu pielegniarskim, dlatego upowszechnianie tego typu opracowan wydaje sie pomocne w codziennej pracy.

Radical chemotherapy of massively disseminated testicular cancer in a 24-year-old patient with acute renal failure and cancer cachexia — case report

We present a case of a 24-year-old patient with metastatic testicular cancer, with massive dissemination to the lung, mediastinum, and abdominal organs, generalised lymphadenopathy, and accompanying acute renal failure due to the compression of the ureters by lymph node conglomerates. The patient underwent radical chemotherapy — initially at doses adequate for renal function together with periodically applied haemodialysis, subsequently in full doses. Two lines of the chemotherapy were applied. The cycles were administered according to the planned rhythm with no deferrals. The applied treatment resulted in relief of the symptoms of the disease and partial regression of the lesions in imaging studies. The persistent lesions have presented no signs of progression since November 2016 to the present day.

PTEN – clinical significance in colorectal cancer

Phosphatase and tensin homolog deleted on chromosome ten (PTEN ) is a human suppressor gene. Its protein product is a bispecific phosphatase playing the complex role in the cell cycle regulating processes and apoptosis by the mechanism of signal transduction into the cell via tyrosine kinase B signaling pathway (PI3K/Akt/mTOR). Reduction or loss of PTEN function is implicated in the pathogenesis of many malignancies, including colorectal cancer. A gradual decrease in the function of PTEN in the sequence of transformations: normal tissue–polyp–adenocarcinoma – disseminated cancer was indicated. The relation between the PTEN loss and the higher clinical severity of colorectal cancer was observed, i.a. higher TNM status and higher tendency to form metastases, leading in some of the studies to shortened patients survival during the observation period. The potential predictive value of the PTEN function loss for the EGFR-targeted therapy in patients with advanced colorectal cancer is the subject of controversy. The potential application of PTEN assessment in clinical practice as a prognostic and/or predictive factor requires further well-designed prospective studies on larger patient population, using the unified methodology. The aim of the study is to summarize the current knowledge on the role of PTEN gene and PTEN protein in the pathogenesis of colorectal cancer and the role of PTEN in clinical practice. KEY WORDs: PTEN, colorectal cancer, EGFR-targeted therapy Correspondence: Angelika Copija, MD Department of Clinical Oncology, Regional Specialised Hospital No. 4 in Bytom 41-900 Bytom, al. Legionów 10 e-mail: ang.c@wp.pl Received: 25.02.2016. Accepted: 16.05.2016.

Statins and colorectal cancer

Statins are naturally occurring compounds that inhibit the enzyme 3-hydroxy-3-methyl-glutaryl-CoA reductase. Through their beneficial management of the body’s lipid metabolism, they are widely used medicinal drugs employed extensively in the primary and secondary prevention of cardiovascular disease. In addition, many studies to date have shown the therapeutic advantages derived from using statins in conditions such as endometriosis, osteoporosis, polycystic ovary syndrome and rheumatic disease. Due to the steady increase of cancer morbidity rates, as demonstrated by epidemiological data, the putative role of statins in treating or preventing cancer has been ever more frequently investigated; including for colorectal cancer. This paper attempts to bring together current knowledge/ evidence on statin therapy targeted at the development, disease course and treatment of colorectal cancer, both in terms of epidemiological findings and clinical observations. Because of the reported link between metabolic disorders and the development of colorectal cancer, particular focus is given to the effects of statins on signalling pathways involving insulin-like growth factors (IGFs).

Mikulicz’S Procedure with Levator Muscle and External Anal Sphincter Plasty in the Treatment of Rectal Prolapse

UNLABELLED Rectal prolapse is the partial or complete protrusion of the rectal wall into the anal canal. The most common etiology consists in the insufficiency of the diaphragm of the lesser pelvis and anal sphincter apparatus. Methods of surgical treatment involve perineal or abdominal approach surgical procedures. The aim of the study was to present the method of surgical rectal prolapse treatment, according to Mikuliczs procedure by means of the perineal approach, based on our own experience and literature review. MATERIAL AND METHODS The study group comprised 16 patients, including 14 women and 2 men, aged between 38 and 82 years admitted to the department, due to rectal prolapse, during the period between 2000 and 2012. Nine female patients, aged between 68 and 82 years (mean age-76.3 years) with fullthickness rectal prolapse underwent surgery by means of Mikuliczs method with levator muscle and external anal sphincter plasty. The most common comorbidities amongst patients operated by means of Mikuliczs method included cardiovascular and metabolic diseases. RESULTS Mean hospitalization was 14.4 days (ranging between 12 and 17 days). Despite advanced age and poor general condition of the patients, complications during the perioperative period were not observed. Good early and late functional results were achieved. The degree of anal sphincter continence was determined 6-8 weeks after surgery showing significant improvement, as compared to results obtained prior to surgery. One case of recurrence consisting in mucosal prolapse was noted, being treated surgically by means of Whiteheads method. Good treatment results were observed. CONCLUSION Transperineal rectosigmoidectomy using Mikuliczs method with levator muscle and external anal sphincter plasty seems to be an effective, minimally invasive and relatively safe procedure that does not require general anesthesia. It is recommended in case of patients with significant comorbidities and high surgical risk.