International Journal of Cancer Management
Volume:11 Issue: 2, Feb 2018

Enhancer of zeste homolog 2 (EZH2) is a catalytic subunit of Polycomb Repressor Complex 2. PRC2 catalyzes methylation of H3K27me and it silences specific gene transcriptions. EZH2 is known to play a vital role in cancer initiation, development, progression, metastasis, and drug resistance. The expression of EZH2 is regulated by a variety of oncogenic transcription factors, tumor suppressor micro-RNAs, and cancer-associated non-coding RNAs. Post-translational modifications also control EZH2 activity. The altered expression of EZH2 has major implication in altering cellular plasticity and, hence, understanding various deleterious mutations can help comprehend its role in cancer metastasis.
The aim of this study is to summarize the data from COSMIC into useful information from the perspective of severity of the mutations in EZH2 and their contributory role as a potential biomarker in diagnosis and therapeutics associated cancers.
Data mining was carried out for various SNPs in EZH2 SET domain from COSMIC, and the severity of each mutation on the functionality of the enzyme was analyzed, using multiple online in-silico tools. The frequently deleterious SNPs were further subjected to advanced tools to understand the changes which render the enzyme functionally erratic during cancer.
The results obtained enhanced the understanding of EZH2 mutation and predicted the plausible biomarkers that could be targeted for the purpose of diagnosis and therapeutics. About 14 prospective biomarkers for various cancers were identified and, further, their role in altering the EZH2 function was discussed.
The various predictive and prognostic impacts of these SNPs in the selected residues are discussed which can be efficiently targeted for an improved cancer diagnosis and designing appropriate treatment strategies.

Early detection and reliable diagnosis of breast cancer could lead to improved cure rates and reduce mortality and management costs.
To explore the potential of texture analysis based on run-length matrix features for classifying benign and malignant breast tumors in ultrasound imaging.
A total of 70 breast tumors (38 benign and 32 malignant) have used in the proposed computer-aided diagnosis system. Twenty run-length matrix features have extracted for texture analysis in three normalizations (default, 3sigma, and 1% - 99%). Linear discriminant analysis and principal component analysis have employed to transform raw data to lower-dimensional spaces and increase discriminative power. The features have classified by the first nearest neighbor classifier.
The features under 3sigma normalization have designed via Linear discriminant analysis indicated high performance in classifying benign and malignant breast tumors with a sensitivity of 96.87%, specificity of 100%, accuracy of 98.57%, positive predictive value of 100%, and negative predictive value of 97.43%. The area under receiver operating characteristic curve was 0.992.
Run-length matrix features had a high potential to characterize and could help radiologist to diagnosis breast tumors.

Occupational exposure to anti-neoplastic drugs (ANPDs) is still a concern among oncology health care workers.
The current study aims at evaluating the knowledge, attitude, and practice (KAP) of oncology nurses towards the safe handling of ANPDs as well as determining the educational needs for the promotion of safe behaviours.
A cross sectional study was conducted between November 2014 and August 2015 in 6 university hospitals in Iran. A specialized questionnaire (4 sections and 49-items) was developed by a clinical pharmacologist and an occupational toxicologist in order to assess the KAP of oncology nurses in terms of safe handling of ANPDs.
A total of 80 nurses responded to the questionnaire. The KAP scores of oncology nurses towards the safe handling of ANPDs were fairly satisfactory. The mean scores of responses for knowledge, attitude, and practice were 54.30 ± 10.86 out of 65, 32.83 ± 5.88 out of 40, and 50.35 ± 10.21 out of 60, respectively. About half of the nurses were trained in oncology ward (by in-service training) and most of them used unreliable sources of information for safe handling of ANPDs.
While the nurses’ knowledge in safe handling of ANPDs is acceptable, training providers and information sources are not appropriate. An ongoing educational program provided by expert pharmacists could decrease the occupational exposure to ANPDs.

As one of the most malignant neoplasm of salivary glands, adenoid cystic carcinoma (ACC) displays epithelial and myoepithelial differentiation. The myoepithelial cells seem to act as tumor-suppressor via their secretory properties.
The present study was designed to evaluate the prognostic significance of p63 (myoepithelial cell marker), maspin, and MMP-2 expression in samples of ACC.
P63, maspin, and MMP-2 expression were examined immunohistochemically in 32 cases with ACC. The relationship between markers expression and clinicopathologic data was assessed, using non-parametric tests and t test.
P63 and maspin expression demonstrated inverse significant correlation with histologic grade, respectively (P = 0.045, P = 0.019). Indeed, association between P63 and maspin expression was observed (r = 0.588, P According to the correlation of P63 and maspin expression with histologic grade, as a prognostic determinant of ACC, P63 and maspin can be useful markers for predicting biologic behavior of ACC, which may lead to new treatment modality in salivary gland tumors containing myoepithelial cell. Furthermore, tumor size can be considered as an indicator of lymph node metastasis.

The optimal management of highly invasive ovarian cancer has changed from adjuvant chemotherapy after surgery to neoadjuvant chemotherapy followed by interval debulking surgery. Generally, tissue specimen for definitive diagnosis of ovarian malignancy is necessary. However, abdominal wall metastasis is a complication, known as transabdominal ascites aspiration or percutaneous core needle biopsy. When neoadjuvant chemotherapy is indicated, transvaginal core needle biopsy under sonographic guidance provided enough tissue specimens. In addition, resection of most of upper vaginal wall during surgery prevents needle site metastasis. The aim of this study is to evaluate transvaginal core needle biopsy as a safe method for diagnosis of ovarian cancer.
This clinical trial study was performed on patients who were candidate for neoadjuvant chemotherapy and were referred to gynecology oncology department of Ghaem Hospital, Mashhad University of Medical Sciences during 2014 to 2015.
Twelve women with a presumptive diagnosis of stage III c or IV ovarian cancer were selected. Adequate sample was obtained by transvaginal core needle biopsy, and cancer diagnosis was confirmed in all cases. This procedure resulted in optimal debulking surgery in 2 /3 of cases.
Transvaginal core needle biopsy is a safe diagnostic method of ovarian cancer.

The present study was conducted to investigate the diagnostic value of spectral Doppler ultrasound in determining malignant potential of breast masses.
The dedicated B-mode and Doppler (including color and spectral) breast ultrasound examinations were performed on 100 consecutive women with breast mass (mean age = 45.02 years). The findings were compared between benign (n = 65) and malignant (n = 35) groups, regarding the histopathologic results. Receiver operating characteristic (ROC) curve was used to determine the optimal cut-off point for each spectral Doppler index.
On B-mode ultrasound, malignant breast masses tended to have bigger size, irregular and ill-defined border, cystic components, and mixed echogenicity (P Doppler examination has a significant role in the evaluation of breast masses and adds value to the B-mode ultrasound for distinguishing malignant tumors from benign lesions.

Small cell lung cancer (SCLC) accounts for 20% of lung cancers with aggressive presentation. Therapies for SCLC have lagged behind the current standard treatment, the prevailing state-of-the-art from the early 1980s. The aim of this study is to report the epidemiological, clinical profile, therapeutic protocols, and results of SCLC in Tunisian population.
This is a retrospective study, including 60 patients treated for histologically diagnosed with SCLC between 2011 and 2015. Only patients with eastern cooperative oncology group (ECOG) performance status 0 to 2 were considered.
Sixty patients were enrolled in this study. The mean age was 61.8 years (range 45 - 77 years). Fifty-five (95%) patients were active smokers. The most frequent symptoms were cough, chest pain, and dyspnea. SCLC was staged as extensive disease in 40 patients (66.7%) and limited disease in 20 cases (33.3%). For diffuse stages, chemotherapy was possible in 34 (85 %) of patients. We observed 2 (5%) complete responses, 9 (22.5%) partial responses, 3 (7.5%) stable diseases, and 9 (22.5%) progressions. Only 11 patients (27.5%) received second line chemotherapy with a median time to progression of 2.2 months. Five patients died, 1 had partial response, and 3 had progressive disease. One patient received third line chemotherapy. For localized stages, 7 (35%) patients received concomitant radiochemotherapy, 5 (25%) primary chemotherapy followed by concomitant radiochemotherapy, and 8 (40%) sequential treatment. Two (10%) patients had complete response, 8 (40%) partial response, 3 (15%) stable disease, 4 (20%) progressive disease, and 1 patient died. Twelve patients relapsed (60%) with a median time to progression of 2 months. Ten patients received relapse chemotherapy. Four patients died from their disease and 4 had a progressive disease. The median survival was 10 months for the overall population, 12.5 months, and 9 months for localized stages and diffuse stages, respectively.
In diffuse SCLC and even with ECOG performance status 0 to 2, first line chemotherapy was feasible in only 85% of cases and second line in only 27.5%. In localized disease, upfront therapy and relapse therapy were possible for 100% and 83% of cases, respectively.

The epidermal growth factor receptor (EGFR) has critical roles in signal transduction pathways, leading to cell growth and differentiation. EGFR expression levels vary among different breast tumor subtypes and ethnic groups. On the other hand, the relationship between EGFR expression at the mRNA level with clinicopathological characteristics in breast cancer has rarely been reported.
The present study focuses on the assessment of EGFR mRNA expression in breast tumors and the association of its expression with various clinicopathological features in Iranian patients with breast cancer.
In this cross sectional study, the expression of EGFR was assessed by real time PCR technique in tumors of 52 Iranian women (27 luminal and 25 triple negative tumors) with primary breast cancer and 6 normal breast tissues.
The results of this study showed that EGFR mRNA was overexpressed only in triple negative tumors, and there is a high frequency of EGFR underexpression in luminal breast tumors, unlike triple negative tumors. We demonstrated that there is a significant positive correlation (r = 0.662) between EGFR expression and the size of luminal tumors. In the current study, the increased expression of EGFR is significantly associated with estrogen receptor (ER) negative, progesterone receptor (PR) negative, and grade III in breast tumors.
These findings suggest that the majority of patients with triple negative tumors are likely eligible to receive the anti-EGFR therapies. Also, it seems that EGFR expression probably has an association with tumor size in luminal subtype of breast tumors.

Complete lymph node necrosis is a rare condition. Excisional biopsy of infarcted lymph node could wrongly lead physicians to benign diagnoses such as Kikuchi-Fujimoto disease, while malignant lymphoma progresses.
A 33-year-old man was referred with gradual enlargement of a left submandibular mass which had recently become painful. The patient had no dysphagia, odynophagia, dysphonia, dyspnea, coughing, nasal obstruction, tooth ache or epistaxis. Three masses were detected by physical examination and computed tomography. There were no signs of malignancy in fine needle aspiration and excisional biopsy. The patient was finally diagnosed by core needle biopsy under ultrasonography guidance and a second excisional biopsy.
The core needle biopsy under ultrasonography guidance could help choosing the optimal lymph node among multiple necrotizing lymph nodes and would prevent more invasive procedures. We emphasize that physicians should keep a high clinical suspicion for lymphoma even if the initial excisional biopsy of an infarcted lymph node is negative.

Endometriosis is a condition in which endometrial tissue exists outside the uterine cavity. Urinary tract lesions are present in 1 % of women with this condition.
A 34-year-old woman was presented to our clinic with a 3-year history of dysuria and frequency. Her past medical history was significant for cesarean sections, performed 3 years earlier. In our center, the patient underwent cystoscopy and transurethral resection of a lesion found in the bladder wall, which on histopathology examination appeared to be endometriosis. A course of six-month hormonal therapy with luteinizing hormone-releasing hormone (LHRH)-agonist (Dipherelin™ 3.75 IM per 28 day) was planned for her. One month later, trans-vaginal ultrasound revealed a nodule posterior to the bladder, which had grown 1 cm in the preceding month. Therefore, Hysterectomy, bilateral oophorectomy, and partial cystectomy were performed. The pathology report was Mullerianosis. During two years of follow up, the patient remained asymptomatic.
Endometriosis and endocervicosis should be regarded as important differential diagnoses in patients with gross hematuria and those suspected to have urothelial carcinomas.