Investigating the Influence of Preoperative Trans Arterial Embolization (TAE) and Predictive Potential of Circulating Tumor Cells (CTCs) in Prognosis of Hepatocellular Carcinoma.

Introduction: Circulating tumor cells are a promising biomarker in many malignancies. CTC dissemination during the operative procedure can lead to disease recurrence. The effect of preoperative transarterial embolization on the release of CTCs and miRNA panels and oncological outcomes in large hepatocellular carcinomas has been evaluated. Materials and methods: The study included non-metastatic HCC >5 cm in size, that were completely resected after TAE (n = 10). Blood was collected pre-TAE, post-TAE, postoperative (day 2,30 and 180) and analyzed for the presence of CTC and miRNA (miR-885-5p, miR-22-3p, miR-642b-5p). The samples were subjected to CTC enrichment, isolation and staining using the markers CD45, EpCAM, and cytokeratin (CK). The data was analyzed using Gene Expression Suite software. Results: The CTC enumeration resulted in three groups: Group 1- CTC present at both pre-TAE and postoperative day 30 (n = 4), Group 2- CTC present at pre-TAE and clearing at postoperative day 30 (n = 2), Group 3- No CTC detected at any stages (n = 3). Group 2 patients had better survival compared with the other groups. Downregulation of miRNA 22-3p also had favorable prognostic implications. Conclusion: Although preoperative TAE does not seem to impact CTC shedding, CTC clearance may prove to be a valuable biomarker in prognosticating HCC. A larger study to evaluate the significance of CTCs as a prognostic marker is warranted to further evaluate these findings.

The conundrum of total neoadjuvant therapy in rectal cancer.

Total neoadjuvant therapy (TNT) has fast become the paradigm in the management of rectal cancer. The widespread adoption of this approach across the world, not only for locally advanced cancers but even for cancers that otherwise would not merit chemotherapy, leads both to an increase in treatment-related toxicity for patients and burdens the healthcare services of the country. It is important to tailor treatment to each patient based not only on the tumour but, even more importantly, on the patient's expectations and goals. The intent of treatment while prescribing TNT needs to be clear, understanding that not all patients are suitable for an organ preservation (watch and wait) approach and that the survival benefits of TNT are not as obvious as most proponents believe.

Colon cancer: feeling the imbalance?

While neoadjuvant chemotherapy has become the standard of care for rectal cancers in most centres, there is much interest in neoadjuvant chemotherapy in colon cancer after the recent publication of the FOxTROT trial. The management of colon cancers seems to be heading down the same path as rectal cancer, where the radicality of surgery is replaced by chemotherapy intensification. The role of demanding procedures such as complete mesocolic excision with central venous ligation in this new paradigm of upfront chemotherapy remains uncertain and uninvestigated.

Splenic flexure cancer: is right extended hemicolectomy better than left hemicolectomy?

INTRODUCTION: There is no consensus on the optimal surgery for splenic flexure cancers. METHODS: Review of a prospectively maintained database of patients with splenic flexure cancer undergoing either a right extended hemicolectomy or left hemicolectomy at a tertiary care cancer hospital from 14.5.2010 to 16.9.2021. The primary outcome measures were postoperative morbidity and hospital stay with secondary outcomes being overall survival, disease-free survival, and long-term patient reported functional and quality of life outcomes. RESULTS: The demographic variables were evenly distributed between groups, and median follow-up was 44 months. The groups were comparable in terms of postoperative morbidity (Clavien-Dindo complication ≥ 3a 10.6% vs 10%, p = 0.322) and hospital stay (8 days vs 7 days, p = 0.316). Oncological outcomes were similar in both groups (3-year disease-free survival 71.8% vs 67.8%, p = 0.877, and 3-year overall survival 83.9% vs 75.8%, p = 0.787), and long-term patient-reported functional outcomes were excellent in both groups. CONCLUSION: Oncological outcomes, post operative morbidity, and long-term patient reported functional outcomes are comparable in patients undergoing either a right extended or left hemicolectomy for splenic flexure cancer.

The RAPIDO trial-Reduction in disease-related treatment failure does not translate into improved overall survival: a mystery solved!

The initial publication of the RAPIDO trial resulted in widespread adoption of short-course radiotherapy and consolidation chemotherapy in locally advanced rectal cancer. The impressive reduction in disease-related treatment failure did not, however, translate into any overall survival benefit. The recent update of the RAPIDO trial with its 5-year results provides much insight into the actual effect that this approach has on patient outcomes and the detriment in local control leads to the question as to whether this approach can still be considered as standard of care in high-risk rectal cancer.

The Psychosocial Implications on Cancer Patients: The Hidden Collateral of the War on Coronavirus Disease 2019.

The coronavirus disease 2019 pandemic has evolved into a pandemic of unheard proportions. Given the havoc wreaked by this pathogen worldwide, many countries have adopted an extreme, legally enforced method of social distancing, in the form of a lockdown. Unless appropriate preventive steps are taken, the cost of the pandemic and ensuing lockdown may prove to be irreparable. The evident implications of this lockdown, such as the escalating levels of unemployment, impending economic collapse, and severe food shortage faced by the sudden unemployed migrant labor population, have been widely reported. Cancer patients are a particularly vulnerable group even during nonpandemic times, often presenting late in the course of their disease, without the resources needed to avail recommended treatment. The prevalence of psychiatric complications and emotional distress is significantly higher than in the general population, and the trauma of both the pandemic and subsequent lockdown adds significantly to their mental trauma. This review is aimed toward addressing the problems faced by cancer patients in the face of this pandemic and subsequent lockdown, with a glimpse into possible solutions that can be implemented.

Generalized hypertrophic lichen planus: an atypical presentation of a characteristic disease.

Lichen planus is a common chronic inflammatory condition that affects skin and mucous membranes. Management is often delayed because of patient embarrassment or misdiagnosis by the clinician. Early recognition and treatment is essential to reduce the morbidity of this condition. We present a 58-year-old woman diagnosed with generalized hypertrophic lichen planus, a rare event, reported to occur usually on lower extremities, but found to be generalized in our patient, requiring excision of symptomatic lesions. We suggest a multidisciplinary approach to allay the anxiety and symptoms of these patients and to improve the quality of life and clinical outcomes.

Exsanguinating Hemorrhage from an Anterior Abdominal Wall Metastasis of an Asymptomatic Renal Cell Carcinoma.

Renal cell carcinoma is the most frequently encountered urological malignancy and accounts for 3% of all adult malignancies. The classically described triad of hematuria, palpable mass, and flank pain is rarely encountered, and most patients are diagnosed by screening done for other reasons. It is notorious for unusual sites of metastatic spread. We present a case of an asymptomatic renal cell carcinoma that presented as an anterior abdominal wall swelling and its neglect led to ulceration, and torrential and exsanguinating hemorrhage to which the patient succumbed.