Mesothelioma in Egypt

Malignant pleural mesothelioma MPM is an increasing problem in Egypt. It is highly related to the use of asbestos in many industries. The problem is not restricted to the small population with work exposure but it is actually a public health problem affecting the large population living within the vicinity of asbestos using factories. Asbestos has been recognized in Egypt since a long time as ancient Egyptians were using it in mummification. Industrialization utilizing asbestos started in Egypt since 1948. Now, there are 14 asbestos factories in Egypt. Asbestos is imported from Russia and Canada and used for the manufacture of asbestos-cement pipes, roofing and wall paneling, valves, ropes, joints, breaks and clutch parts. So, mesothelioma in Egypt is mainly attributed to environmental origin with a relatively high incidence in women and as well as young adults. Epidemiological data for 635 malignant mesothelioma patients over 4 years in the 3rd mellinium were collected from the National Cancer Institute NCI and Abbassia Chest hospital. Residential exposure was clear in 64.7% of cases. The recorded frequency at NCI, Cairo in the last 11 years of the 2nd mellinium, was 148 cases. NCI hospital-based registry showed an increase in the relative frequency of MPM from 0.47% during 2001, to 1.3% during 2003. Field study of the residential area surrounding the oldest asbestos producing plant in Egypt showed that asbestos waste is improperly disposed off in the surrounding residential region. Repeated airborne asbestos samples were collected. Results showed different counts of asbestos fibers in those residential areas ranging from 0.002 f/cc, 7 kilomters from the factory, to 3.02 f/cc few meters of the fence of 3 schools just adjacent to the factory. Conclusion: MPM is a silent killer. All measures towards eliminating it entirely or at least strictly controlling human contact with this dangerous carcinogen have to be taken in order to combat the coming epidemic of mesothelioma in Egypt

prognostic index [BPI] for bilharzial related invasive bladder cancer

This study was done on 180 patients with histopathologically proven invasive bladder cancer associated with bilharziasis. They were subjected to radical cystectomy or anterior pelvic excentration. After surgery, the patients were regularly followed up for a minimum of two years. Squamous cell carcinoma was the commonest type and most of the tumors were grade II. One hundred and seventy-three patients had their tumors operable, while seven patients were inoperable. Five operative related mortalities were recorded. Free and overall survival rates of the whole group of the patients were 31.44 + 5.9% and 32.5 + 6.8%, respectively. Tumor pathologic stage, grade and nodal affection were the only significant factors that affected the survival. These three prognostic indices were used to design a model to predict an individual patientgyptians risk factor for recurrence. Then, the patients were assigned to one of four risk groups according to the score achieved in this prognostic index [0 = low risk, 1 = intermediate risk and 2 or 3 = higher risk]. These four risk groups had distinctly different rates of disease free survival, being 91.7%, 53%, 13% and 7% for low risk, intermediate risk and higher risk groups, respectively

Evaluation of recombinant alpha 2b interferon and 5 fluorouracil in advanced and metastatic colorectal carcinoma

The management of patients with advanced colorectal cancer remains dependent on the optimal use of 5-fluorouracil and its enhanced activity by adding different modulators. Up till now, the best schedule of combining 5-fluorouracil [5 FU] and interferon [IFN] is not yet perfectly discovered. This protocol was used to treat a total of 26 patients with advanced, recurrent of metastatic previously untreated colorectal carcinoma. Seven of the 21 evaluable and measurable disease cases responded to treatment [33.3%], of them 2 had CR [9.5%]. Cases were randomized to receive arm 1 that consisted of 5 FU 600 mg/m2/d bolus injection weekly and 6 millions of 5 FU 600 mg/m2 continuous infusion for 5 days and 6 million units of interferon Sc. for the same period, to be repeated every 21 days. Responses were achieved in 3/10 and 4/11 in the 1st and 2nd arms, respectively, with 1 CR in each arm of therapy. Toxicity was mild and reversible in both arms. Different radiological modalities, CEA and CA 19-9 were used to monitor prognosis of the disease. The median duration for responders was 10 months+. The median survival was 8 months+ and 9 months+ in the 1st, and 2nd arms, respectively. The clinical activity and low toxicity of the combination of 5 FU and interferon is encouraging the best responses were achieved in the cases having low tumor burden or minimal residual disease after surgery for recurrence

sequential use of tamoxifen and provera in the treatment of recurrent and metastatic breast cancer

Twenty postmenopausal patients with recurrent or metastatic breast cancer were treated prospectively with cycles of tamoxifen [10 mg bid] for 7 days followed by oral provera [200 mg bid] for 21 days. The median age of this group was 52 years [age range 35 to 61 years]. Fourteen out of these 20 patients were >/ 50 years old. Response rate [CR + PR] was 9/20 [45%]. The duration of response ranged between 3 months and 5.5 + years with a mean of 14 months. The response rate was 71% among the patients with disease free survival 2 years or more while it was only 11% in patients with disease free interval < 2 years. The response rate was 8/12 [66.6%] in the group of patients that had skin and soft tissue metastasis compared to 1/8 [12.5%] when the disease was involving the lung and bone. Toxicities were mild and reversible. The mean survival in patients who showed objective response was 20 months, [27 months among CR cases] compared to 11 months in non responders. Patients with visceral or osseous metastasis had a median survival of 13.5 months while it was 18 months in soft tissue metastatic cases. It is concluded that the sequential use of tamoxifen-provera is effective for patients with recurrent and metastatic breast cancer