Schistosomiasis and cancer in Egypt: review

Schistosomiasis is not known to be associated with any malignant disease other than bladder cancer. Bladder cancer is still the most common malignant tumor among males in Egypt and some African and Middle East countries. However, the frequency rate of bladder cancer has declined significantly during the last 25 years. This drop is mainly related to the control of Schistosomiasis. Many studies have elucidated the pathogenic events of Schistosomal-related bladder cancer with a suggested theory of pathogenesis. Furthermore, the disease presents with a distinct clinicopathologic profile that is quite different from bladder cancer elsewhere with younger age at presentation, more male predominance, more invasive stages, and occurrence of squamous cell carcinoma pathologic subtype. However, recent data suggest that this profile has been dramatically changed over the past 25 years leading to minimization of the differences between its features in Egypt and that in Western countries. Management of muscle-invasive localized disease is mainly surgery with 5-year survival rates of 30-50%. Although still a debatable issue, adjuvant and neoadjuvant chemotherapy and radiotherapy have improved treatment outcomes including survival and bladder preservation rates in most studies. This controversy emphasizes the need of individualized treatment options based on a prognostic index or other factors that can define the higher risk groups where more aggressive therapy is needed. The treatment for locally advanced and/or metastatic disease has passed through a series of clinical trials since 1970s. These phase II and III trials have included the use of single agent and combination of chemotherapy and radiotherapy regimens. The current standard of systemic chemotherapy of generally fit patients is now the gemcitabine-cisplatin combination. In conclusion, a changing pattern of bladder cancer in Egypt is clearly observed. This is mainly due to the success in the control of Schistosomiasis. It may also be due to increased exposure to other etiologic factors that include smoking, pesticides, and/or other causative agents. This change will ultimately affect disease management

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

Fungus infections in leukaemic patients under immunosuppressive therapy

50 cases of haematologic malignant patients were studied. They were under immunosuppressive treatment. Isolation and identification of fungal infection were studied in throat washs, rectal swabs and blood cultures. These cases were selected from inpatients of National Cancer Institute, Cairo University with age ranged from 2 years to 50 years old. The incidence of fungal infection in each group was 70.5% in acute myeloid leukaemia [AML], 67% in acute lymphatic leukaemia [ALL] and 50% in malignant lymphoma. The only two cases available of chronic myeloid leukarmia [CML] were positive. The common fungal pathogens in our patients were Candida albicans followed by Candida tropicalis, Candida pseudotropicalis, Candida kruzei and Aspergillus species

Effect of combination chemotherapy on the clinical response of malignant lymphoma

This study included 56 patients with advanced stages of malignant lymphoma: 36 NHL, and 20 HD. The most common pathological subtypes were diffuse poorly differentiated lymphocytic in NHL and mixed cellularity in HD, both of which are known to be of unfavorable prognosis. Conventional combination chemotherapy produced nearly the same CR rate in both HD [57%] and NHL [50%], whereas the <> chemotherapy was more effective in HD [CR rate with MOPP-6 = 71.4%] and less effective in NHL [CR rate with CHOP= 40%, and CHOP-L 33.3%]. Although <> combinations were known to be better for clearing the disease, additional toxicities of these combinations apparently resulted in disturbing the patient-tumor relationship. This might explain the poorer response of NHL patients who received the aggressive combinations