Emre Akar

Isolated Uterine Metastasis of Invasive Ductal Carcinoma

Introduction. Most common metastasis sites of breast cancer are the lungs, bones, liver, and brain, whereas uterine involvement by metastatic breast disease is rare. Metastatic carcinoma of the uterus usually originates from other genital sites, most commonly being from the ovaries. Invasive lobular carcinoma spreads to gynecologic organs more frequently than invasive ductal carcinoma. Case Report. A 57-year-old postmenopausal woman was diagnosed with breast carcinoma 2 years ago and modified radical mastectomy was performed. Pathological examination of tumor revealed invasive ductal carcinoma, stage IIIc. She presented with abdominal pain and distension. Diagnostic workup and gynecologic examination revealed lesions that caused diffuse thickening of the uterus wall. Endometrial sampling was performed for confirmation of the diagnosis. She underwent total abdominal hysterectomy and bilateral salpingo-oophorectomy. Breast carcinoma metastases in endometrium and myometrium were confirmed histopathologically and immunohistochemically. Conclusion. We herein report the first case of isolated uterine patient who had invasive ductal carcinoma of breast.

Herbal Administration and Interaction of Cancer Treatment

The widespread impact of cancer worldwide and noncurative treatment methods despite all developments drive patients towards investigating and using nonconventional treatment methods. Herbs, which have an important role in complementary and alternative medicine practices, may cause unfavorable results when used especially with chemotherapeutics in cancer patients due to the substances they contain and due to the properties of some, which still cannot be clarified. Further overshadowing the success of the treatments, patients do not talk about these issues with their doctors and physicians are unable to comprehend these properties of herbs. In this compilation we aimed to clarify the concepts of complementary and alternative medicine, to gather the properties of important and frequently used herbs, and to increase the awareness of physicians on this subject.

Cancer Pain Prevalence and its Management

Pain is a public health problem affecting more than half of cancer patients. Despite the success of the protocols currently used, pain cannot still be reduced satisfactorily in the large majority of patients. In order to improve pain management, all healthcare professionals involved with pain should have sufficient knowledge on pain assessment and treatment, and should inform patients to prevent patient-related barriers. In this compilation, the prevalence values and the treatment methods of cancer pain, and the barriers to pain management have been assessed.

PET-CT changes the management and improves outcome in patients with recurrent colorectal cancer

BACKGROUND The present study aims to analyze the impact of positron emission tomography/computed tomography (PET/CT) on management change in patients with suspected or proven colorectal cancer recurrence, and to assess the effect of this management change on progression-free survival (PFS) and overall survival (OS). MATERIALS AND METHODS We retrospectively evaluated 122 patients with suspected potentially resectable recurrent colorectal cancer who underwent PET/CT scan. We determined management plans for these patients before and after the PET/CT examination. RESULTS While previous conventional imaging studies had revealed solitary metastases, additional sites of disease were determined by PET/CT scan in 52/122 (42%) patients. PET/CT examination results changed the treatment plan to curative intent in 35 (37%) patients. While the median PFS was 22 months (95% CI, 11.2-32.6 months) among the patients planned to receive curative treatment after the PET/CT scan, it was 11 months (95% CI, 8.1-13.9 months) in patients planned to receive curative treatment before the PET/CT examination, and the difference between median PFS durations was statistically significant (HR, 0.51 [95% CI, 0.32 - 0.88], P = 0.004). Furthermore, OS was significantly longer in patients planned to receive curative treatment after the PET/CT scan (27 months [95% CI, 22.1-31.9]) compared with those who received curative treatment before the PET/CT scan (21 months [95% CI, 15.6 - 26.4]), and the difference was statistically significant (HR, 0.63 [95% CI, 0.42 - 0.89], P = 0.045). CONCLUSION The present study demonstrates the significant impact of PET/CT on the management and outcome in patients with recurrent colorectal cancer.

Severe liver dysfunction and safe use of 5-fluorouracil leucovorin and oxaliplatin in one patient with metastatic colorectal carcinoma

The liver is the most frequent site of metastases in colorectal cancer. Commonly used anticancer drugs in colorectal cancer are 5-fluorouracil, oxaliplatin and irinotecan 5-fluorouracil (5-FU) and oxaliplatin have very few numbers of studies that support their safety in hepatic dysfunction, but pharmacokinetic studies of anticancer drugs focused on the single-agents; however, there is lack of data about drug combinations such as 5-fluorouracil leucovorin and oxaliplatin (FOLFOX) and 5-fluorourocil, leucovorin and irinotecan (FOLFIRI) regimens. We demonstrated one patient with colorectal cancer and severe liver dysfunction secondary to hepatic metastases. Laboratory investigation on admission showed total bilirubin 22.5 mg/dl, alkaline phosphatase 1137 IU/l, aspartate amino transferase 254 IU/l, alanine aminotransferase 164 IU/l and carcinoembryonic antigen levels 863 ng/ml. We initiated a 5-FU/oxaliplatin-based combination chemotherapy. Our data supports the safety and feasibility of FOLFOX regimen in patients with severe liver dysfunction secondary to liver metastases of colorectal cancer.

Malignant Clinical Presentation of a Benign Granular Cell Tumor of Breast in a Patient with Previously Treated Contralateral Invasive Ductal Carcinoma

GCT is a rare neoplasm and usually shows the benign character. GCT can occur in any body site and may be multifocal. The most common involved site is tongue which accounts for nearly 30% of all cases but skin and subcutaneous tissue are also affected frequently. Breast is an unusually involved site and accounts for 6% of all GCTs. The histiogenesis of GCT is still controversial but further investigations and immunohistochemical examinations were exposed to neural origin and the tumor is thought to be derived from Schwann cells of peripheral nerves. Generally used technique to diagnose GCT is the positivity of S-100 immunohistochemical staining. Despite its benign nature, GCT may mimic breast carsinoma clinically and radiologically and easily be misdiagnosed for breast cancer. We herein report a case of granular cell tumor that arose in a 56 year-old female patient who previously had been treated from an invasive ductal carcinoma in contralateral breast.

Late relapse of testicular cancer: Recurrence after 24 years and treatment with chemotherapy alone.

Late relapse of testicular cancer, defined as >2 years interval between initial treatment and recurrence, is a rare disease with the incidence rate of 2.6%. Due to its chemoresistant features, treatment options of late relapses are controversial while surgical approach and cisplatin-based chemotherapies can be considered. We report here a patient with nonseminomatous germ cell tumor who experienced relapse 24 years after his first diagnosis. After detecting left supraclavicular lymphadenopathy and absence of any other malignant lesion in positron emission tomography-computerized tomography, patient was treated with three cycles of VeIP regimen (vinblastine/ifosfamide/cisplatin). Second complete response to this treatment was achieved with chemotherapy alone.

Gastric cancer: A case study in Turkey

OBJECTIVE The aim of this study was to determine age-specific incidence ratios, gastric cancer localization trend, histologic subtype and cancer related survival that whether have changed during the period from 1999 to 2010. MATERIALS AND METHODS A total of 866 gastric cancer patients treated at the hospital were retrospectively evaluated. Categorical and continuous variables were summarized using descriptive statistics and were compared using the Chi-square and Mann-Whitney U-tests, respectively. Cancer related survival rates were estimated by the Kaplan-Meier method. RESULTS The median age at diagnosis was 58 years. Trends concerning the median ages of the patients were increased (from 57 years to 59 years). The proportion of diffuse histological subtype gastric adenocarcinoma increased during the period from 1999 to 2010, and it was 27% between 1999 and 2002 and 32% between 2007 and 2010 (P = 0.04). The proportion of gastric adenocarcinoma localized in cardia increased during the period from 1999 to 2010, and was 7.2% between 1999 and 2002; and 22.5% in 2007 and 2010 (P = 0.004). For stage I that was diagnosed between 1999 and 2002, the relative survival was 67% and in patients diagnosed between 2007 and 2010 the rate was 85%. For stage II that was diagnosed between 1999 and 2002, the relative survival was 35% and in patients diagnosed between 2007 and 2010, the rate was 65%. Cox regression analysis was conducted based on age subgroup, diagnosis time, and gastric localization (proximal/distal) and for adenocarcinoma subtypes. Hazard ratio was 31.6 for stage IV (confidence interval [CI] = 10-42), 1.3 for cardia localization (CI = 1.04-1.6) and 1.37 for patients who had been diagnosed between 1999 and 2002 (1.14-1.78). CONCLUSIONS The ratio of median age at diagnosis and proximal gastric adenocarcinoma, diffuse histologic subtype increased between 1999 and 2010. Cancer related survival significantly improved for stage I and stage II. Cardia localization and time of diagnosis between 1999 and 2002 had significantly poor outcome on relative survival.