International Journal of Cancer Management
Volume:10 Issue: 12, Dec 2017

Context: Epididymis is highly rich by L-carnitine (LC), which serves as a protectant agent for the oxidation process and also has key roles in energy production and motility enhancement. Progress in cancer survivor beside dramatic increase in cancer prevalence has led to universal interest for fertility preservation in survival of patients with cancer. Recently, a trend is established for evaluating the effects of LC and its ester supplementation on radio and chemotherapy induced gonadal injury. This article focused on chemotherapy induced infertility, mechanisms involved, and the possible protective role of LC.
Evidence Acquisition: All papers including clinical trials, case reports, case series, and reviews on the role of LC in the cancer induced infertility were obtained by searching in medical publications such as Elsevier, PubMed, Google Scholar, and clinical trials.
L-carnitine pre-treatment was effective in improving sperm parameters, especially total motility, viability, reducing cell apoptosis; it was also able to promote the quality of the semen exacerbated by chemotherapy agents such as etoposide, doxorubicin, and cyclophosphamide in animal model.
According to animal studies, the administration of LC could show a promising protective data, but before any judgment, further large controlled studies are required and issue is matter of concern in future studies.

Context: MicroRNAs (miRNAs) have recently been found to be important targets for cancer therapy in innate immunity. Such molecules are highly expressed in a wide variety of tumor cells and play an important role in immune responses, such as apoptosis.
Evidence Acquisition: We searched PubMed, Medline, Scopus and google scholar databases for the studies published from January, 1998 to October, 2017 with the following keywords: “TLRS”, “MicroRNA”, “cancer”, “HMGB1”, and “Melanoma”
MiRNAs are mainly classified into 2 different groups, tumor suppressors and oncogenes. MiRNAs are closely related to damage-associated molecular patterns and pathogen-associated molecular patterns through the innate immunity signaling pathways, such as Toll-like receptors (TLRs). This review was carried out to find the relation between melanoma miRNAs with innate immune signaling pathways, such as toll-like receptors and high-mobility group box 1. High-mobility groups (HMG) are danger signal molecules, which can involve damage-associated molecular patterns and manage microRNAs.
The important point in this field is that miRNA targeted in the immune defense can regulate inflammatory cytokines and alter cancerous phenotypes.

Colorectal cancer is the major cause of death worldwide. Recently, cancer immunotherapy has been used in cancer prevention and treatment which has led to immune system response to cancerous cells and their elimination. Recent studies were conducted to specifically target tumor marker to design vaccine.
Here, we designed a vaccine chimeric including CEA and CA19-9 against colorectal cancer.
The construct was analyzed, using bioinformatics tools and servers. The physicochemical properties, structures, antigenicity, stability, MHC binding properties, and ligand-receptor docking of chimeric protein (CE-CA) were predicted.
The results showed the structure of CE-CA has suitable form and separates each domain; furthermore, the epitope mapping did not change after combination.
The results showed that the construct can be appropriate vaccine against colorectal cancer and could generate potent immune response against this cancer. In silico tools are useful to design vaccine.

The present study was conducted with the aim of investigating the mediating roles of the cognitive emotion regulation strategies (CERS) and goal adjustment in relationship between personality characteristics and quality of life of patients with cancer.
The method of this study was a descriptive-explanatory one. The population of the study consisted of patients with cancer referred to 4 health care centers. A total of 156 people (males: 49, females:107) were selected by convenience sampling and they completed the Persian scales of the cognitive emotion regulation, goals adjustment, short-form of 5 personality factors and the world health organization quality of life.
The general characteristics of the pattern test suggested a lack of fit of the initial model proposed by the researchers. In order to find a better fit, several corrections were made based on the theoretical and experimental principles and general indicators from testing the initial model (χ2 = 129.71, df (degree of freedom) = 98, RMSEA (root mean square error of approximation) = 0.082, GFI (goodness of fit index) = 0.87, AGFI (adjusted goodness of fit index) = 0.82). According to this model, the extroversion and neuroticism variables, respectively, have positive and negative direct effects on the quality of life of patients with cancer. Also, extroversion has a positive indirect effect due to the adaptive strategies of CERS and goal adjustment, and the neuroticism variable has indirect negative effects on the quality of life of these patients due to the adaptive strategies of CERS and goal adjustment (P > 0.00).
Considering the results, that 2 major factors affecting the quality of life of patients with cancer are goal adjustment and CERS; this relationship should be taken into account in the training for treatment programs involving CERS and especially adaptive strategies as well as goal adjustment.

The present study aimed to investigate the relationship between self-care and pain control in patients with cancer.
In this cross-sectional study (October to December, 2015) 380 cancer patients were admitted to one of the hospitals affiliated to Mazandaran University of Medical Sciences (Sari, Iran) entered to the study using simple random sampling. Data was collected by a demographic questionnaire, self-care scale and McGill pain questionnaire. The statistical package for social sciences, version 20.0 (SPSS Inc., Chicago, IL, USA) was utilized for data analysis by descriptive and infernal statistic tests (Spearman’s correlation and Generalized Linear models).
Males in the study (48.39 ± 13 ± 39; CI95: 46.41 - 50.38) were older than females (45.33 ± 18.44; CI95: 42.79 - 47.87). Based on the results of the processing of the Generalized Linear Models, there was not a significant relationship between pain perception and self-care in cancer patients (P > 0.05). But there was a significant relationship between pain perception and its two subsets of physical self-care (B = -1.102, P Considering the adverse effects of chronic pain treatment process and secondary problems, more comprehensive studies must be done about the effects of self-care behaviors on the perception of pain so that effective steps can be taken to intervene and promote the health of these patients.

Acute toxicities in patients with prostate cancer who accede to radiation therapy usually affect the patients’ quality of life and these toxicities are sometimes dose limiting.
This study was performed to determine the efficacy and safety of celecoxib together with radiation therapy.
Forty prostate cancer patients undergoing external beam radiotherapy (EBRT) were enrolled to receive either placebo or celecoxib. The patients received external-beam radiotherapy up to 70 Gy daily fractions of 1.8 - 2 Gy. The patients received oral celecoxib or placebo 200 mg twice daily. The first celecoxib or placebo was administered 3 hours before each radiotherapy fraction and the second, 12 hours after the first consumption. RTOG based gastrointestinal (GI) and genitourinary (GU) acute toxicity scoring were performed pre-treatment, at least once weekly during radiotherapy and once 1 month after the end of the treatment.
Celecoxib was well tolerated. Thirty-nine patients (39/40) fully completed treatment according to protocol. No grade 4 toxicity was seen in two groups. A significant reduction in GU ≥ 2 toxicity was observed in the celecoxib group (P = 0. 006). No significant difference was found between the two groups with respect to GI ≥ 2 toxicity (P = 0. 621).
We demonstrated that the combination of celecoxib with radiotherapy is well tolerated and decreased acute toxicities especially GU toxicity in patients with prostate cancer.

Zinc (Zn) and Selenium (Se) are trace minerals that have high anti-cancer and chemopreventive properties.
This study aimed at evaluating the serum levels of both elements in women with breast cancer (BC) compared with control group and the correlation of them with risk factors of BC.
In a case-control study, 142 women with BC and 158 healthy controls, aged 19 to 88 years, were selected. Both groups did not use any type of supplement 3 months before participation in the study; there was no history of chronic kidney or liver disease or malabsorption disorders among the participants and body mass index was between 18.5 and 30 based on Quetelet index. The Se by graphite furnace and Zn by flame were atomized and the amount of each of 2 elements was measured and recorded by the Absorption device.
The mean Zn was 689.57 ± 146.13 mg/dL in the patient group and 874.85 ± 150.53 mg/dL in the control group (P Decreasing the serum levels of Se and Zn may be the risk factors for BC. It seems that adding micronutrients of Zn and Se in patients with low serum levels may reduce the risk of BC.

Microsatellite instability, the main genetic element in HNPCC syndrome, is associated with a number of cancers, including ovarian epithelial carcinomas. These cancers have distinct characteristics compared to non-MSI related ones.
The present study aims at determining the prevalence of microsatellite instability in ovarian carcinomas and their associated factors in Iranian patients.
Paraffin-embedded blocks, belonging to 37 patients with definite diagnosis of ovarian epithelial cancers, were retrieved from the archives. After DNA extraction from tumor tissue and PCR reaction, the results were assessed in accordance with melting curve analysis. Subsequently, the relationship among microsatellite status and tumor histology, grade, stage, and size were investigated statistically.
The predominant histological type was serous histology. Four out of 37 carcinomas were microsatellite unstable (10.8%) and only 1 was MSI-high type (2.1%). The MSI was more frequent among younger patients with unilateral, non-serous histology, non-high grade, and stage I tumors without omental involvement. After statistical analysis, the only significant relationship was found between histological type (non-serous) and microsatellite status.
Microsatellite stable and unstable ovarian cancers may have different associations with various factors in a sample of Iranian women. The identification of these characteristics may help narrow down indications to test this prognostic and predictive genetic error.

Colorectal carcinoma is one of most common cancers in Iran with increasing incidence. The mean age of the affected is decreasing. With progresses in multimodality treatment, we witnessed improved prognosis in colorectal cancers.
This study aimed at evaluating the outcomes of patients with rectal adenocarcinoma treated with neoadjuvant chemoradiotherapy followed by surgery.
In this retrospective cohort study, we assessed the oncologic treatment outcomes of patients with locally advanced (T3-4 or N) rectal adenocarcinoma in our high volume cancer center, Iran cancer institute, Tehran, Iran. Patients with synchronous metastasis, previous malignancy, and history of pelvic radiation were excluded. The primary endpoint was overall survival (OS) rate and secondary endpoints were disease-free survival and pathologic response.
Of patients being treated between 2008 and 2014, 158 were entered to final analysis; they completed planned neoadjuvant treatment and retuned after surgery with pathology report. The mean age was 56 years and mean interval from radiotherapy to surgery was 9 weeks. Thirty percent achieved pathologic complete response. Two-year overall and disease-free survival rate was 87% and 80%, respectively. In multivariate analysis age, sex, local recurrence, clinical stage, and radiotherapy to surgery interval failed to predict OS. The pathologic response (complete vs. non-complete) and the absence of distant metastasis were independent predictors of OS.
The rate of pathologic response and survival in our series was comparable to other big randomized studies in the world and even better than previous national reports. These findings emphasize the necessity of treating patients with locally advanced rectal cancer in high volume centers.

Breast cancer is the most frequent malignancy in Iranian women. Pathogenic mutations in BRCA1 and BRCA2 genes account for 20% to 25% of familial breast cancer. BRCA1 and BRCA2 mutation frequencies differ considerably among various geographic regions and ethnicities. Most studies have primarily used Caucasian populations to delineate the population and family risks associated with germline BRCA1 and BRCA2 mutations, leaving patients of other ancestries understudied. As genetic testing for BRCA1 and BRCA2 mutations is underused in Iran, it is of great importance to be able to describe the mutation spectrum of these genes and subsequently the genetic risks and testing benefits particular to Iranian population.
We designed a pilot study to identify the full spectrum of BRCA1 and BRCA2 sequence variations and large single or multi-exonic deletions in 20 Iranian breast cancer patients with a high likelihood of hereditary predisposition to breast cancer. Manchester score, as a validated scoring system for the probability of carrying a BRCA1/2 mutation, was calculated for all patients to determine the cut-off value for genetic testing in Iranian families.
Two pathogenic [c.4566C > G (p.Tyr1522Ter), c.1961delA (p.Lys654Serfs*47)] and one likely pathogenic (c.5153-26A > G) variants in BRCA1 and 2 pathogenic variants [c.8165C > G (p.Thr2722Arg), c.92G > A (p.Trp31Ter)] in BRCA2 gene were identified. Assuming a Manchester score of 20 points as cut-off value to perform BRCA genetic testing, this scoring system has a sensitivity of 80%, specificity of 60%, positive predictive value (PPV) of 40%, and negative predictive value (NPV) of 90%.
Considering the high cost of testing in Iran, it seems that that the cut-off value of 20 points is more appropriate.

Epidermoid cysts (ECs) are rare, slow growing tumors which usually affect lumbosacral area as an extramedullary lesion and mostly associated with spinal malformations. In this report we describe a very rare case of multi-segmental intramedullary EC.
A 42- year-old male presented with low back pain and paresthesia of left lower limb and also intermittent urinary retention. Urodynamic study showed weak contractions in bladder. MRI demonstrated multi-segmental lobulated intramedullary lesion extending from C7 to L2, which has high intensity on both T1 and T2-weighted images. Laminectomy of T11-L3 for symptomatic parts of the lesion and subtotal resection of the tumor was performed and histopathological investigation confirmed EC.
Prompt evaluation of every patient with combination of neurological and urologic disturbances should be carried out. This report suggests that rare intraspinal tumors such as EC may affect multiple locations of the spinal cord, thus appropriate surgical intervention may prevent unwanted sequelae.

The research evidence supports the effectiveness of acupuncture as an alternative or supplementary therapy for back pain and some of musculoskeletal pains. On the other hand, the use of opioids in the management of cancer pain is common. The effectiveness of acupuncture on the amount of pain and the level of cortisol in opioid-dependent patients has not been addressed so far.
A 54-year-old man with metastatic cancer under chemotherapy and methadone maintenance treatment after 4 weeks of assessment at baseline received an auricular acupuncture treatment for 1 month. Saliva Cortisol Index was evaluated, using Salvi tests and the pain level was evaluated twice a week through a visual analog scale (VAS). Data were analyzed, using multiple baseline method in the form of pattern A-B.
Primary outcome showed that cortisol levels decreased significantly during the acupuncture treatment. Secondary outcomes showed that acupuncture was accompanied by a decrease in the back pain. These findings, in addition to confirmation of the effectiveness of acupuncture on psychological and biological indicators, indicate the role of complementary therapies in cancer management and its side effects.