Biliary tract cancers: SEOM clinical guidelines

Biliary tract cancer (BTC) is an uncommon and highly fatal malignancy. It is composed of three main different entities; Gall bladder carcinoma (GBC), intrahepatic cholangiocarcinoma (iCC) and extrahepatic cholangiocarcinoma (eCC) sharing different genetic, risk factors and clinical presentation. Multidetector-row computed tomography (MDCT) and magnetic resonance cholangio-pancreatography (MRCP) are the more important diagnostic techniques. Surgery is the only potentially curative therapy but disease recurrence is frequent. Treatment with chemotherapy, radiotherapy or both has not demonstrated survival benefit in the adjuvant setting. Cisplatin plus gemcitabine constitutes the gold standard in metastatic disease. New ongoing studies mainly in the adjuvant and neoadjuvant setting along with molecular research will hopefully help to improve survival and quality of life of this disease (AU)

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Biliary tract cancers: SEOM clinical guidelines.

Biliary tract cancer (BTC) is an uncommon and highly fatal malignancy. It is composed of three main different entities; Gall bladder carcinoma (GBC), intrahepatic cholangiocarcinoma (iCC) and extrahepatic cholangiocarcinoma (eCC) sharing different genetic, risk factors and clinical presentation. Multidetector-row computed tomography (MDCT) and magnetic resonance cholangio-pancreatography (MRCP) are the more important diagnostic techniques. Surgery is the only potentially curative therapy but disease recurrence is frequent. Treatment with chemotherapy, radiotherapy or both has not demonstrated survival benefit in the adjuvant setting. Cisplatin plus gemcitabine constitutes the gold standard in metastatic disease. New ongoing studies mainly in the adjuvant and neoadjuvant setting along with molecular research will hopefully help to improve survival and quality of life of this disease.

Descriptive analysis of clinical factors affecting terminally ill cancer patients.

GOALS OF WORK: To make a descriptive analysis of clinical and laboratories parameters in advanced neoplastic patients. MATERIALS AND METHODS: We interviewed 406 terminally ill cancer patients to study demographic and neoplastic data, 24 graded symptoms, 21 analytical parameters and scales to evaluate general condition, quality of life and independence in daily activities. MAIN RESULTS: An average of 9.3 symptoms per patient were detected and median survival was 26.5 days. Most frequent symptoms were asthenia (96.8%), anorexia (94.8%), weight loss (88.1%) and pain (80.5%). Principal laboratory abnormalities were high blood sedimentation rate (96%), high cytolysis and cholestasis enzyme levels (50-77%), anemia (81.5%), low protein (66%) and low albumin levels (67%). Symptom prevalence was different according to age, gender, primary tumour, location of metastasis, laboratory parameters, performance status, quality of life or independence in daily-living activities. CONCLUSIONS: We should know more frequent symptoms affecting terminal cancer patients and any factor contributing to it to provide more comfort in the final phases of life.

Employment in a cohort of breast cancer patients.

BACKGROUND: Breast cancer survivors can have problems in returning to work. However, the importance of work to cancer survivors has until recently received little attention. AIMS: To investigate employment- and work-related disability in a cohort of breast cancer patients to identify possible discrimination and other obstacles to remaining in work. METHODS: Questionnaire study of breast cancer patients employed at diagnosis and where diagnosis had been confirmed at least 6 months before the interview. Participants completed a questionnaire concerning cancer-related symptoms and work-related factors and clinical details were obtained from their medical records. RESULTS: The study included 96 consecutive patients with breast cancer aged between 18 and 65 years. In total, 80% of patients were unable to work after diagnosis, but 56% returned to work at the end of treatment. The sequelae of the disease or its treatment and the stage of disease were independently associated with the ability to work after the end of treatment. Only one patient did not tell his/her employers and coworkers about his/her disease. In total, 29% noticed changes in their relation with co-workers and managers, usually in the sense that they tried to be helpful. None reported job discrimination. CONCLUSION: Breast cancer survivors in this study encountered some problems in returning to work, mainly linked to the sequelae of their disease and its treatment rather than to discrimination by employers or colleagues.

Actividad laboral en una cohorte de pacientes con linfoma no Hodgkin / No disponible

Introducción: La actividad laboral en el cáncer es un aspecto psicosocial que ha recibido poca atención hasta el momento actual, a pesar de considerarse una dimensión de la calidad de vida para estos pacientes. Objetivos: La reinserción y adaptación al entorno laboral fueron investigados en una cohorte de pacientes con linfoma no Hodgkin para describir los factores que influyen en la vuelta al trabajo de estos enfermos. Pacientes y métodos: El estudio incluyó 37 pacientes consecutivos diagnosticados de un linfoma no Hodgkin y empleados en el momento del diagnóstico. El cuestionario incluyó aspectos epidemiológicos, clínicos y laborales (32 variables en total). El estudio fue aprobado por el Comité Ético y de Investigación Cínica del Hospital La Paz. Todos los pacientes dieron su consentimiento para participar en el estudio y para la utilización de los datos de su historia clínica. Resultados: El 86,5% de los pacientes pasaron a inactivos tras comenzar el tratamiento de la enfermedad y un 32,5% lo seguían estando tras éste. No hubo diferencias en la influencia de las distintas variables analizadas con respecto a la actividad laboral tras el diagnóstico. Sin embargo, el realizar un trabajo predominantemente físico y la presencia de secuelas derivadas del tumor o del tratamiento de éste, sí influyeron en la reinserción laboral una vez finalizado el tratamiento específico. La mayoría de los pacientes no creían que el tener la enfermedad les perjudicaría en su puesto de trabajo y, en casi todos los casos, tanto sus compañeros como sus jefes conocían que tenían un tumor. Conclusiones: Éste es el primer estudio exploratorio en nuestro país acerca de la reinserción laboral de los pacientes diagnosticados de un linfoma. Son necesarios más trabajos para establecer las dificultades que tienen este tipo de enfermos en la reinserción laboral y establecer las medidas adecuadas para la mejora de este proceso

Background: Cancer affects many dimensions determining quality of life, including work. However, the importance of work to cancer survivors has received little attention. Aim. Employment and work-related disability were investigated in a cohort of non-Hodgkin's lymphoma patients to describe a possible discrimination and other work issues. Patients and Methods: The study included consecutively 37 non-Hodgkin's lymphoma patients who were employed at diagnosis. The questionnaire included cancer related symptoms and work-related factors. Clinical details were obtained from the medical record. Patients were interviewed face to face and 32 variables were recorded. The study was approved by the Ethical Committee of Hospital La Paz. All patients gave consent to participate. Results: Eighty-six per cent of patients were unable to work after diagnosis, but 68% returned to work at the end of treatment. The type of worker and the sequelae of the disease or its treatment were independently associated with the ability to work after the end of treatment. Almost all patients told their employers and co-workers about their disease. None reported job discrimination. Conclusions: This is the first exploratory study in Spain about labour reintegration in non-Hodgkin's lymphomas. Further studies are necessary

[Primary intestinal T lymphoma: a report of two cases and a review of the literature]. / Linfoma T primario intestinal: a propósito de dos casos con revisión de la literatura.

Lymphomas of the gastrointestinal tract are the most common type of primary extranodal lymphomas and about 15-20% of these are primary intestinal lymphomas. They may be or B or T- cell. Intestinal T-cell lymphomas are much less common and they can be enteropathy-associated. This disease occurs in adults with abdominal pain often associated with intestinal perforation. The course is aggressive. The major problem is to distinguish this disease from a benign ulcer. Two cases with differents clinical and pathologic features are reported with a review in the literature of this uncommon entity.

Linfoma T primario intestinal: a propósito de dos casos con revisión de la literatura / Primary intestinal T lymphoma: a report of two cases with a review of the literature

Los linfomas del tracto gastrointestinal son el tipo más frecuente de linfomas extraganglionares y de éstos el 15-20 per cent son de localización intestinal. Pueden ser B o T. Los linfomas tipo T son menos comunes y pueden estar o no asociados a enteropatía. Suelen aparecer en adultos en forma de dolor abdominal a menudo asociado a perforación intestinal. El curso es agresivo. El mayor problema es hacer el diagnóstico diferencial con las úlceras benignas. Se presentan dos casos de diferentes características y evolución y que permiten realizar una revisión de las características clinicopatológicas de esta rara entidad. (AU)

Presentación clínica atípica de un tumor testicular fundido. Revisión de la literatura / Atypical clinical presentation of a burned out testicular tumor. Review of the literature

Propósito: Se presenta un caso de tumor testicular fundido que se manifiesta de forma atípica con múltiples metástasis hepáticas y pulmonares. Se analiza el diagnóstico diferencial con el tumor germinal extragonadal y su importancia clínica. Observación clínica: Varón de 42 años que debuta con lesiones pulmonares y hepáticas de origen desconocido. La necropsia demostró metástasis de tumor germinal mixto (coriocarcinoma y carcinoma embrionario) y una fibrosis tubulo-intersticial en el testículo derecho. Conclusiones: En todo varón joven con sospecha de enfermedad tumoral, especialmente si la evolución clínica es rápida, hay que plantearse la posibilidad de un tumor germinal y descartar, mediante ecografía y eventual estudio histológico, la presencia de una neoplasia testicular (AU)

[Superior vena cava syndrome: presentation of six cases]. / Síndrome de vena cava superior: presentación de seis casos.

Superior vena cava syndrome is a devastating complication of obstructive lesions compromising the superior vena cava an its branches. Most cases today are caused by malignant tumors. The most frequent are lung carcinoma. The clinical presentation is dyspnea, vuvular enlargement, collateral circulation. Imaging techniques and histological confirmation are used for diagnosis. Early diagnosis and treatment is needed. The following report deals with six patients with superior vena cava syndrome. All entered our hospital through Emergency Department. The description of the principal symptoms and sings, the early diagnosis and the treatment.

Varón de 63 años con síndrome general y masa esplénica / 63-year old male patient with general syndrome and splenic mass

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Linfoma primario óseo: a propósito de dos casos con revisión de la literatura / Bone primary lymphoma: report of two cases and review of the literature

Propósito: El linfoma primario óseo es una rara forma de linfoma extranodal que representa menos de un 1 por ciento de los linfomas no Hodgkin. Su diagnóstico puede ser difícil por los síntomas de presentación y las características radiológicas, a veces similares a las de otras enfermedades óseas. En general tiene un buen pronóstico tras el tratamiento aunque éste no ha sido completamente definido. Material y métodos: Se presentan dos pacientes que presentaron esta enfermedad pero con distintas edades, síntomas y localización del tumor. Resultados y conclusiones: Estos casos permiten tener la oportunidad de revisar esta infrecuente neoplasia que tiene una supervivencia libre de enfermedad a los ocho años cercana al 100 por ciento (AU)

Reinserción laboral del paciente neoplásico / Reintegration to work of the patients with cancer

Propósito: Analizar la reinserción laboral en los pacientes diagnosticados de cáncer. Material y métodos: Se ha realizado una encuesta a 96 pacientes neoplásicos que desempeñaban un empleo remunerado en el momento del diagnóstico. Resultados: Durante el tratamiento, 8 pacientes (9 por ciento) permanecieron laboralmente activos y 79 (82 por ciento) tuvieron ILT. Tras finalizar éste, 67 enfermos (70 por ciento) desarrollaban alguna actividad laboral y 11 (11 por ciento) continuaban con ILT. Quedaron con secuelas 48 personas (50 por ciento), de las cuales 24 (50 por ciento) pudieron volver al trabajo, frente a 43 (90 por ciento) de las que no presentaron secuelas (p<0,01). Conclusiones: El 70 por ciento de los pacientes que sobreviven al tratamiento de primera línea de una neoplasia logran reinsertarse en el ámbito laboral. Es necesario desarrollar esquemas terapéuticos que, manteniendo la eficacia, reluzcan al mínimo las secuelas (AU)

Circulating cancer cells in peripheral blood. A case report.

BACKGROUND: Carcinocythemia, the presence of circulating cancer cells in peripheral blood, is a rare complication of solid neoplasms. When the number of such cells is very high, they can be detected during routine laboratory tests. They are associated with a dismal prognosis. CASE REPORT: Carcinocythemia occurred in a patient with disseminated breast cancer. Eighteen cases were identified from a review of the literature. The most common neoplasms associated with circulating cancer cells in peripheral blood were breast adenocarcinoma, small cell lung carcinoma and rhabdomyosarcoma. All the patients had stage IV disease at the time of diagnosis, and all had involvement of the reticuloendothelial system. Patients survived for an average of a few days or weeks. CONCLUSION: Circulating cancer cells in peripheral blood are an unusual manifestation of disseminated neoplasms that occurs as a terminal event.

Failure of goserelin ovarian ablation in premenopausal women with breast cancer: two case reports.

OBJECTIVE: We hereby report on two patients receiving goserelin due to breast cancer in whom a failure in ovarian ablation was detected. A review of the hormonal effects of LHRH analogues is performed. CASE REPORTS: CASE 1: A 36-year-old female was diagnosed with breast carcinoma and treated with surgery, chemotherapy, radiotherapy, and goserelin. A 16-week gestation was detected after 17 months of uninterrumpted hormonal therapy at ablative doses. CASE 2: A 41-year-old female was diagnosed with breast carcinoma and treated with surgery, chemotherapy, radiotherapy, and tamoxifen. Goserelin was substituted for tamoxifen due to bone metastases and, 2 years later, a failure in ovarian ablation was confirmed after the reappearance of the patient's menses. CONCLUSIONS: Goserelin-induced ovarian ablation may fail after the use of appropriate doses of this drug. We suggest a possible mechanism of hormone resistance induced by the long-term administration of LHRH analogues. No fetal damage was detected after goserelin exposure in the first 4 months of gestation.

Pregnancy in a breast cancer patient treated with a LHRH analogue at ablative doses.

A 36-year-old female diagnosed of breast cancer was treated with surgery, chemotherapy, radiotherapy and goserelin. After 17 months of uninterrupted therapy with this LHRH analogue at hormone suppressive doses, a 16-week gestation foetus was detected and the treatment was withdrawn. Although the drug was administered throughout the first 4 months of pregnancy it resulted in the term delivery of a healthy infant, and no foetal adverse effects were detected. A review of the influence of hormonal treatment for breast cancer on fertility and birth defects has been performed.