Middle East Journal of Cancer
Volume:10 Issue: 1, Jan 2019

Cross-sectional observational studies reveal that cancer is more prevalent in depressed persons. Psychosocial stressors such as depression, anxiety, stressful life events, poverty, and lack of social support may favor carcinogenesis. Cancer acquired under these circumstances has a poor prognosis. Conversely, when cancer has developed in the presence of these factors, effective management or treatment of these psychosocial stressors may bring about increased survival time of the affected persons. The of this narrative literature review is to examine the role that maladaptive stress responses play in cancer initiation and progression. Relevant databases, hand searches and authorative texts were critically analysed and the findings were integrated. Stress is influenced by genetic, environmental, pharmacological, and infectious factors in addition to the chronicity of depression, social isolation, and poor stress-coping capacity. Chronic psychosocial stress-induced maladaptive activation of the neuroendocrine system may dysregulate immunoinflammatory responses, alter oncogene expression, promote tumor-related angiogenesis, and accelerate growth of cancer with stimulation of neuroendocrine activity, which may favor cancer progression. The evidence that associates psychosocial stressors to cancer progression is stronger than
the evidence which links the same psychosocial stressors to cancer incidence.

Gastric cancer is one of the most common malignancies worldwide with a high case mortality rate. In metastatic gastric cancer, a proper combination of chemotherapy could increase the survival rate. The goal of this study is to evaluate the efficacy and safety of the combination regimen of irinotecan, oxaliplatin, and Xeloda in metastatic gastric cancer. A total of 45 patients with metastatic gastric cancer and good performance status according to the Eastern Cooperative Oncology Group (score: 0-1) received the irinotecan, oxaliplatin, and Xeloda chemotherapy regimen. Demographic data, responses to treatment, and adverse effects were gathered for all cases. Overall survival and progression-free survival rates for patients were calculated using the Kaplan-Meier estimate. Patients’ mean age was 58.3 ± 11.3 years (range: 24-81). There were 73.4% male patients and 26.6% female patients. Anorexia and weight loss were the most common symptoms. Overall response rate was 50%. The majority of toxicities were anemia, nausea and vomiting (grades 1 and 2), diarrhea (grades 1 and 2), neutropenia, alopecia, and hand and foot syndrome. The one-year progression-free survival rate was 31.5 ± 7.5%, whereas the twoyear progression-free survival rate was zero. The one-year overall survival rate was 34.91 ± 8.5%. Patients had a two-year overall survival rate of 7.7 ± 6.6%. Diffuse type cancer was linked to an inferior outcome. Regardless of our limited number of patients, this combination could be a suitable regimen for metastatic gastric cancer in terms of low toxicity, acceptable response rate, and survival results.

Cancer antigen 15-3 and carcinoembryonic antigen are used in clinical and laboratory diagnosis of metastatic breast cancer. Previous studies have noted conflicting results about the association between carcinoembryonic antigen and cancer antigen 15-3 in metastatic breast cancer. The present study examined serum tumor marker levels of carcinoembryonic antigen and cancer antigen 15-3 among patients with different subtypes of metastatic breast cancer. In this cross-sectional study, we assessed metastatic breast cancer patients diagnosed between 2005 and 2012 who referred to academic Hospitals affiliated with Mashhad University of Medical Sciences. The patients were selected by systematic randomization sampling. Demographic, clinical, pathological, and therapeutic data were collected from patients’ hospital records. Statistical analyses were performed by Statistical Package for the Social Sciences version 16.0 software. A total of 298 eligible patients enrolled in the study. Patients’ median age was 48.39±12.57 years. Elevated serum levels of carcinoembryonic antigen were identified in 65.17% of patients and cancer antigen 15-3 in 57.29% of patients. Based on molecular subtype categorization, 109 (39.5%) patients were human epidermal growth factor receptor 2 negative and 105 (38.0%) patients were in the luminal group. There was no significant correlation between serum carcinoembryonic antigen and cancer antigen 15-3 with subtypes of the tumor. The most common sites for metastasis were bones and liver, respectively. However, there was no significant correlation between serum carcinoembryonic antigen and cancer antigen 15-3 with the site of metastasis. There was a significant association between serum carcinoembryonic antigen level and stages IIA and IV. One of the most significant findings of the current study was the increased serum carcinoembryonic antigen and cancer antigen 15-3 levels in most metastatic breast cancer participants. We postulate that regular measurement of serum cancer antigen 15-3 and carcinoembryonic antigen could be useful for earlier detection and prediction of outcomes.

Cervical cancer is the most common gynecologic cancer in developing countries. Although this malignancy is preventable, problems exist with screening this cancer. Numerous studies have researched immunohistochemistry methods, such as the KI-67 biomarker as a proliferation marker, to improve screening for cervical intraepithelial neoplasia as the precancerous phase of cervical cancer. These studies mostly screened cytological samples. In the current study, we sought to analyze the correlation between the KI-67 proliferative biomarker and HPV infection in order to predict short-time prognosis in cervical intraepithelial neoplasia as an alternative or ancillary method to current screening methods. Our assessment was based on histologic samples from a different geographic population. This descriptive cohort prospective study included 40 patients diagnosed with low grade cervical intraepithelial neoplasia based on cervical punch biopsy samples after colposcopy examination. We enrolled patients who referred to the Department of Gynecology- Oncology of an academic hospital of Mashhad University of Medical Sciences from 2016 to 2017. All low grade cervical intraepithelial neoplasia samples were investigated for HR-HPV DNA with the Cobas test and immunostaining for the KI-67 biomarker. After a one-year follow-up, we evaluated the prognosis for all patients based on liquid based cytology and HRHPV test. Data were analyzed by SPSS version 23.0 and the Mann-Whitney U and Fisher's exact tests. A P-value < 0.05 was considered significant. We observed a significant difference between HR-HPV positive and negative tests in KI-67 expression (P<0.001), but there were no significant differences in reactivity level of cervical epithelium (P=0.5) and in KI-67 expressions in metaplastic and non-metaplastic epithelium (P=0.88). After one year, most low grade cervical intraepithelial neoplasia cases in group A that had a low staining KI-67 biomarker had evidence of regression. On the contrary, all cases with high grade KI-67 expression didn’t persist or progressed necessarily. The KI-67 biomarker is recommended as a complementary screening test, but not an alternative for triage of high-risk patients with low grade cervical intraepithelial neoplasia. Patients with low grade cervical intraepithelial neoplasia/HR-HPV positive cervical samples and low staining KI-67 antigen could be offered a less aggressive follow-up protocol.

Receptor tyrosine-protein kinase ERBB2, also known as human epidermal growth factor receptor-2 (HER2), is heterogeneously expressed in a variety of human cancers, including bladder cancer. Based on previous studies that show its association with bladder cancer progression, HER2 has been included in novel multiplatform biomarkers for prediction of bladder cancer prognosis. However, the clinical significance of HER2 status remains underinvestigated and poorly linked to the patients’ clinicopathological features. Here, we aim to scrutinize the levels of the extracellular domain of HER2 in the sera of bladder cancer patients and correlate these levels with clinicopathological features of the tumor. In the present analytical cross-sectional study, we enrolled 60 pathologically confirmed bladder cancer patients along with 20 age-sex matched healthy controls, and compared their serum HER2 levels as measured by enzyme-linked immunosorbent assay. We observed no statistically significant difference when comparing the levels of HER2 in the sera of cases and controls (P>0.05). Interestingly, serum HER2 levels of controls were higher than bladder cancer patients who had lymph node metastasis (P=0.036). Serum levels of HER2 were also higher in controls than bladder cancer patients with perineural invasion (P=0.028). We observed significantly higher HER2 serum levels in transitional cell carcinoma patients in comparison to non-transitional cell carcinoma patients (P=0.016). Our observations are suggestive of the absence of any association between bladder cancer prognostic factors and serum HER2 levels. To draw any definitive conclusion, further studies with larger sample sizes that examine the presence of neutralizing auto-antibodies against serum HER2, immunohistochemistry examination of HER2 in bladder tumor and lymph node samples, and urinary HER2 levels, along with measurement of its serum levels would be helpful.

Bone morphogenetic proteins are a family of cytokines and growth factors that are involved in tumorigenesis. ZCCHC12 (SIZN1), as a transcriptional coactivator of bone morphogenetic protein signaling, is identified as a positive regulator of central nervous system development during embryogenesis. It positively regulates the CREB and AP1 transcription factors that cooperate with the bone morphogenetic protein signaling pathway. In the present study, SIZN1 mRNA expression was assessed in esophageal squamous cell carcinoma patients. The levels of SIZN1 mRNA expression in tumor tissues from 50 patients with esophageal squamous cell carcinoma were compared with their corresponding normal margins by using real-time polymerase chain reaction. We observed that 10 out of 50 (20%) cases overexpressed SIZN1, whereas 40 out of 50 (80%) cases showed either normal or under expression of SIZN1. There was a significant correlation between the levels of SIZN1 mRNA expression and tumor depth of invasion (P=0.040). Furthermore, a significant correlation between lymph node metastasis and SIZN1 mRNA expression was observed in esophageal squamous cell carcinoma patients (P=0.036). This study is the first report that has assessed SIZN1 expression in esophageal squamous cell carcinoma patients. SIZN1 can be a potential therapeutic target for primary esophageal squamous cell carcinoma because of its role in the early stages of tumor progression and metastasis.

Quality assessment and service delivery processes for cancer patients are the major components of palliative care. This study intends to explore stakeholder’s perceptions of palliative care process challenges for cancer patients in Iran. In this qualitative study, we conducted 22 semi-structured interviews from February 2016 to August 2017 in hospitals located in Tehran, Iran. Participants were selected through purposive sampling and included cancer patients, their family caregivers, healthcare providers, and policy-makers. The interviews were analyzed by qualitative directed content analysis based on the Donabedian model. In order to assess the accuracy and validity of the study, we used Lincoln and Guba’s four criteria. After analysis of the interviews, we categorized the codes into a main category, “process”, and three identified subcategories – “weakness of stakeholders’ engagement policies”, “standardized care”, and “applying educational and research approaches”. Palliative care in Iran is a recent discipline. The results have shown that the process of providing services requires the attention of the health system to the standard models for providing palliative care services. In addition, it is necessary to train human resources in generalist and specialist palliative care groups, design palliative medicine curricula, inform general public about cancer, and empower patients and caregivers.

Diagnosis of lung cancer is often delayed because most of the patients are asymptomatic during the primary cancer stages. Infrared spectroscopy is an improved technique compared with the others for identifying abnormal tissue types because of its spatial and spectral capabilities. Therefore, this study is taking an advanced advantage of the physical and optical properties of the attenuated total reflection Fourier-transform infrared system. The attenuated total reflection Fourier-transform infrared has been applied for cancer detection at infrared wavelengths that range from 4000-400 cm-1. This technique may be a beneficial diagnostic method because it uses the principles of physics, as optics and photonics with a specific wavelength region, which can make an immense difference. The attenuated total reflection Fourier-transform infrared system spectra of normal lung tissue showed main peaks at 3321 and 1637 cm-1, which has been assigned to the OH and C=O function group of amide I and has intensities of approximately 61% (OH) and 76% (C=O). That intensity has been shown to decrease in the cancer tissue. A new peak at 1545 cm-1 appeared in the cancerous tissue, which could be an amide II. The identification of a biochemical component from either normal or cancerous lung tissue would help to evaluate malignant tissue. Thus, the obtained results indicated degradation of the biochemistry component (protein) of the tissue due to carcinogenic disease.

Breast lymphoma is a rare neoplasm that accounts for approximately 0.04-0.5% of breast malignancies. Most breast lymphomas are B-cell type non-Hodgkin lymphomas. The imaging features of breast lymphoma on mammography and ultrasound are nonspecific. There have been several reports on magnetic resonance imaging characteristics of breast lymphoma but only few have described features on diffusion weighted imaging. Herein, we describe the magnetic resonance imaging findings, with emphasis on diffusion weighted imaging and the apparent diffusion coefficient sequences, of two cases of breast lymphoma and compare them with the magnetic resonance imaging features reported in the literature.

Follicular dendritic cell sarcoma is one of the rare and aggressive neoplasms originating from follicular dendritic cells of lymphoid tissues. It commonly presents as asymptomatic lymphadenopathy, but extranodal involvement such as oral cavity, mediastinum, liver, and spleen are also reported. The disease often has an indolent course. Current knowledge on its pathogenesis is limited and due to its rarity, follicular dendritic cell sarcoma has no definite treatment strategy at present. Here we report a case of a 24-year old male with follicular dendritic cell sarcoma of neck, treated with wide local excision, post operative radiation and chemotherapy, and developing pulmonary metastasis after a disease-free period of 15 months.

Renal cell carcinoma is responsible for approximately 80% of malignant tumors of the kidney. Clear cell, papillary, and chromophobe forms comprise the most frequent histological subtypes of renal cell carcinoma. Thyroid-like follicular renal cell carcinoma is an extremely rare subtype of renal cell carcinoma that resembles thyroid follicular neoplasms. Histologic findings should not be confused with chronic pyelonephritis with thyroidization or renal metastasis of thyroid cell carcinoma. There are few reports of thyroid-like follicular renal cell carcinoma. Here, we report a new case of thyroid -like follicular carcinoma of the kidney diagnosed in a partial nephrectomy specimen in a 62-year-old man.