Th. Wobbes

Matrix metalloproteinase 2 and 9 activity in patients with colorectal cancer liver metastasis.

Matrix metalloproteinases (MMPs) have been reported to play an important role in tumour cell invasion and metastasis. The bioactivity of MMPs in liver metastasis from colorectal cancer was investigated and correlated with clinicopathological variables.

Fluorodeoxyglucose-positron emission tomography and sentinel lymph node biopsy in staging primary cutaneous melanoma

AIMnWe report the value of sentinel lymph node (SLN) biopsy and fluorodeoxyglucose-positron emission tomography (FDG-PET) in relation to SLN biopsy in staging primary cutaneous melanoma.nnnMETHODSnFifty-five patients with primary cutaneous melanoma >1.0 mm. Breslow thickness and no palpable regional lymph nodes underwent a FDG-PET scan before SLN biopsy.nnnRESULTSnSLNs were retrieved in 53 patients. Melanoma metastases were found in the SLN of 13 patients. FDG-PET detected the lymph node metastases in two of the 13 patients with SLN metastases. In five patients FDG accumulation was recorded in a regional lymph node basin, while no tumour positive SLN was found. In eight patients FDG-PET showed increased activity at a site of possible distant metastasis. Metastatic disease was confirmed in one patient. No explanation for the positive FDG-PET result could be found in five cases.nnnCONCLUSIONnFDG-PET should not be considered in this group. SLN biopsy reveals regional metastases that are too small to be detected by FDG-PET. The prevalence of distant metastases is too small to justify routine use of FDG-PET.

Impact of [18F]fluorodeoxyglucose positron emission tomography on surgical management of melanoma patients.

Several studies have shown adequate sensitivity and specificity of [18F]fluorodeoxyglucose positron emission tomography (FDG‐PET) for the detection of metastases from melanoma, but few have addressed its impact on treatment. The aim of this retrospective study was to assess the impact of FDG‐PET on treatment of melanoma in three Dutch university medical centres.

Quality of life after surgical treatment of colorectal liver metastases

The surgical approach to colorectal liver metastases is becoming increasingly aggressive. The aim of this prospective study was to evaluate the impact of surgery on health‐related quality of life (HRQoL) of patients with colorectal liver metastases.

The management of clinical emergencies in oncology

The incidence of cancer is remaining constant or slightly increasing in Europe. Due to screening programmes and better multi-modality treatment, the prevalence of cancer is significantly increasing. In addition, the aging population in Europe is rapidly rising. People over the age of 65 years may be diagnosed with a variety of other diseases such as cardiovascular, diabetes, arthritis and obstructive lung disease. Although cardiovascular disease is still the largest cause of death of men and women in Europe, it has recently been replaced in The Netherlands by cancer. In general elderly cancer patients have a variety of co-morbidities, which affect the choice and shortand long-term outcome of cancer treatment. The majority of patients with solid tumours are surgically treated and a fair proportion receive treatment with (neo) adjuvant chemotherapy and/or pre-, perior postoperative radiation treatment. Age is not a contra-indication for surgery and radiation treatment. Adjuvant chemotherapy is increasingly safely given to the elderly. The combined treatment approach led to a breakthrough in the treatment of colo-rectal, breast and ovarian cancer with an increase in disease free and overall survival of over 10−15% [1]. The disadvantage of the combined treatment is the related shortand long-term morbidity, sometimes requiring (acute) surgical intervention. Patients might present with an acute abdomen as the initial symptom of cancer, as a complication related to their initial cancer treatment or related to previous cancer therapy. An initial diagnosis of cancer is made in less than 1% of cases seen in a typical Emergency Department. This figure might be increasing, since more cancer patients receive (high-dose) antitumour therapy and are therefore at risk for acute treatment related morbidity and more cancer patients are prone to long-term treatment induced morbidity. The literature with respect to the pattern of an acute abdomen in cancer patients is rare. Table 1 outlines the spectrum of cancer patients requiring emergency laparotomy in the early 1980s at the Memorial Sloan Kettering Cancer Centre. The laparotomies were performed for complications directly related to cancer in 35%, for complications related to cancer surgery in 44% and the remaining 21% were for reasons unrelated to cancer [2].