Gastric adenocarcinoma in association with tuberous sclerosis case report

We report the first case of gastric cancer in association with tuberous sclerosis. Tuberous sclerosis is an autosomal dominant disorder which presents with a constellation of signs including benign tumours in the brain and in other vital organs such as the kidneys, heart, eyes, lungs, and skin. A combination of symptoms may include seizures, developmental delay, behavioural problems, skin abnormalities, and lung and kidney disease. It is caused by mutations on either of two genes, tuberous sclerosis genes, TSC1 or TSC2, which encode for the proteins hamartin and tuberin respectively. These proteins act as tumour growth suppressor agents that regulate cell proliferation and differentiation. Tuberous sclerosis has been associated with hamartomatous growths and angiomyolipomas, an association with gastric cancer has not been reported; however, this could be a co-incidental finding and further cases need to be reported

Outcome as a measure of quality of care in oncology: experience at Sultan Qaboos University Hospital, Oman

Measurement of outcomes is increasingly employed as an indicator of the quality of clinical care. The most commonly measured outcome in many clinical studies, especially in oncology, still remains the overall survival rate. Sultan Qaboos University Hospital [SQUH], Oman, is striving for excellence through quality management. In seeking continual improvement, quality measurement exercises have been initiated throughout the Hospital. We present the overall survival rate of four of the ten most common cancers diagnosed in Oman. The cancers included non-Hodgkin's lymphoma [NHL], Hodgkin's lymphoma [HL], breast cancer, and stomach cancer. The studies were all retrospective and had been conducted previously. For present purposes, only the overall survival was compared with studies both from the region, and with bench-mark studies. For NHL, with a median follow-up of 8 months, the 2-year overall survival rate was 64%; 90% for low risk, 55% for intermediate risk, and 15% for high risk groups. For HL, the 5-year overall survival rate was 64%; 76% for low risk and 42% for high risk. For breast cancer, the 5-year survival rate was 67%; percentages were 88%, 75% and 59% for Groups I, II, and III respectively. For gastric cancer, the 5-year survival rate was 16.5%; 24% for the non-metastatic group. The outcome of patients with early stages and fewer adverse prognostic factors is comparable to what has been reported in the international literature; however, the outcome is inferior for patients presenting withadvanced stage disease and several adverse prognostic factors

Major advances in the treatment of cancer. What does a non-oncologist need to know?

The last few years have seen major advances in the management of cancers. Since it is not possible for the non-oncologist to keep abreast with the latest developments in the field of oncology, this review summarises the most significant advances in the area of treatment of various cancers over the past four years. In some areas, a paradigm shift has occurred setting new standards of care, for example, the use of targeted therapy [trastuzumab] in adjuvant treatment of breast cancer; the use of monoclonal antibodies[rituximab], with or without chemotherapy, in the treatment and maintenance of indolent lymphoma; the use of the tyrosine kinaseinhibitor, imatinib, in the adjuvant setting in resected gastrointestinal stromal tumours. In other areas, new treatments have emerged,such as, the use of targeted therapies in hepatocellular carcinoma [sorafenib] and renal cell carcinoma [sunitinib, sorafenib, temsirolimus, bevacizumab]. In some other cancers, the addition of targeted therapies has improved survival rates, for example, in colon cancer [bevacizumab, cetuximb, panitumumab], head and neck cancers [cetuximab], and pancreatic adenocarcinoma [erlotinib]. In yet another group, new targeted therapies have emerged where resistance was previously observed with the existing targeted therapies, for example, breast cancer [lapatinib], chronic myeloid leukemia [dasatinib]. Finally, the addition of chemotherapeutic agents has improved survival in some forms of cancer, for example, oxaliplatin in adjuvant treatment of colon cancer, temozolamide in glioblastoma multiforme, and adjuvant chemotherapy in non-small cell lung cancer. The information summarized here may provide useful for the busy physician needing an update in the field of oncology

Nodular lymphocyte predominant Hodgkin's lymphoma presenting as severe hypercalcaemia: a case report

Nodular lymphocyte predominant Hodgkin's lymphoma [NLPHL] is a recently described type of Hodgkin's lymphoma [HL] and accounts for 5-6% of all the cases of HL. Here we report the case of an elderly man who presented to Sultan Qaboos University Hospital, Oman, with severe hypercalcemia, and was diagnosed to have stage IV NLPHL. Although the incidence of hypercalcemia is estimated to be between 1-5% in classical HL, to our knowledge this is the first report of NLPHL presenting with severe hypercalcemia. The patient responded to the anti-CD20 monoclonal antibody, Rituximab, and has been in clinical remission for more than 3 years

Metastatic gastrointestinal stromal tumor and hypercalcemia in a patient with ulcerative colitis

A 45-year-old man suffering from intermittent rectal bleeding was diagnosed with ulcerative colitis involving the descending colon and rectum. After 2 years on ulcerative colitis treatment, he presented with metastatic gastrointestinal tumor, liver and peritoneal spread, and a pelvic mass. Interestingly, he was found to have significant hypercalcemia. He was treated with Imatinib with significant symptomatic and clinical response