[Investigation of glycaemic and nutritional status of patients suffering from cancer.] / Daganatos betegek glykaemiás és tápláltsági állapotának vizsgálata.

INTRODUCTION: Obesity, type 2 diabetes mellitus and cancers are equally endemic in our country. Their partially common metabolism may constitute the base of their similar epidemiology. OBJECTIVE: Proving metabolic relation between glycaemic and nutritional status and progression of cancers, as well as confirming the antitumor effect of non-insulin antidiabetics, primarily metformin. METHOD: We processed the data of 1224 patients treated at the Oncology Center in county Békés. We examined the progression of cancers depending on body mass index, blood glucose levels, the presence and therapy of type 2 diabetes, over and above analyzed changes in glycemic and nutritional status in relation to tumor stage, further more prevalence of diabetes mellitus. RESULTS: Despite of malignant cachexy, we found obesity or corresponding body mass index in relatively high rate (23.28%) more often associated with metastatic stage. We detected higher rate of type 2 diabetes (20.34%) compared to average population. We found even larger scale of diabetes among patients suffering from primary hepatocellular (60%, p<0.001), pancreatic (50%, p<0.001), urinary bladder (50%, p<0.001), prostate (50%, p<0.002), endometrial (50%, p<0.02) and postmenopausal breast cancer (30%, p<0.006), compared to other part of the studied population. Patients treated by non-insulin antidiabetics, taking metformin was accompanied by the lowest incidence of metastatic stage, the highest body mass index and blood glucose level. DISCUSSION: In our study, the order of malignant diseases most frequently associated with type-2 diabetes correspond to previously published literature data. Development of insulin resistance accompanied by tumor progression can be effectively delayed by antimetabolic medicines. The combined antimetastatic effect of metformin could achieve glucose and weight control independently. CONCLUSION: Based on our results, targeted screening for cancer among diabetic patients, and seeking and adequately treating glycometabolic disorders with concomitant malignant conditions, respectively , are suggested, mainly using metformin and new non-insulin antidiabetic medicines. Through these efforts, the fight against cancer can be more effective. Orv Hetil. 2023; 164(23) 900-910.

Oncodiabetology III. The relationship of antineoplastic therapies and carbohydrate metabolism / Onkodiabetológia III. Az antineoplasztikus terápiák és a szénhidrát-anyagcsere viszonya

The epidemiological indicators of malignant diseases and diabetes are changing similarly, as lately both have been dynamically increasing worldwide. They occur usually in the same patient synchronously or metachronously, because of their common metabolic and molecular background. Consequently, in more and more cases they require common treatment. That has led to a new science, called oncodiabetology, the main purpose of which is to optimize the combination of antineoplastic and antidiabetic therapies. Regarding the antineoplastic agents, their complex influence on metabolism has to be considered, especially diabetogenic side effects inducing insulin-resistance and decreasing insulin production. According to antidiabetic agents' role in preventing tumors, diminishing toxicity of cytostatic drugs, and promoting the breakthrough of chemoresistance should be considered. In this study, we investigate the contexts of antineoplastic agents' efficiency and the glucometabolism of the organization, the characteristics of oncotherapy in patients suffering from malignant disease and diabetes, and review those cytostatic agents, having massive diabetogenic adverse effects. We describe the properties and subtypes of secondary diabetes, thoroughly discuss the specific characteristics of hyperglycaemia and diabetes caused by malignant diseases and antineoplastic treatments, especially pancreatic diabetes. In the end, we attempt to determine the proper place and role of oncodiabetology in the treatment of patients suffering from malignancies. During our investigation, we assessed the effects on glucometabolism of the recently used classic cytostatics, molecularly targeted therapies and different endocrine manipulations treating malignancies. We reviewed the schedules and scientific background of almost 300 medicines for this aim. We established that every third antineoplastic agent influenced glucometabolism adversely. We report our further observations in our next reviews.

[Detection of multiple colon and rectal tumors during diagnostic treatment and follow-up]. / Többszörös vastag- és végbéldaganatok felismerése a kivizsgálás, kezelés és gondozás során.

Recognition of the commonly encountered colorectal cancer (CRC) generally begins and takes place because of and based on symptoms and signs, due to the unsettled screening of this type of cancer. Sometimes, because of advanced stage cancer urgent surgical intervention could become necessary and, if this is the case, there is no time and possibility for searching for an eventual second tumor and perhaps the patient's status does not permit performing intraoperative investigations either. The incidence of multiple colon cancer is considered to be between 2.5 and 30% according to the literature. That is why one should exclude them even in the absence of pre- and intraoperative investigations and complaints. On the other hand, colonoscopy and perhaps irrigoscopy of seemingly healthy followed-up patients is mandatory. In the case of the presence of complaints/symptoms denoting impaired intestinal passage seen in a followed-up patient or during the adjuvant setting or metastatic/recurrent disease, treatment and even during hospice care we should evaluate the possibility of a second metachronous tumor. Moreover, if there is no urgency, the multidisciplinary team (oncoteam) should recommend the adequate treatment by balancing gain/utility and risk.

[Thoughts about thromboembolic events prophylaxis in cancer patients]. / Gondolatok a daganatos betegek vénás trombózisprofilaxisáról.

The risk of venous thromboembolic events (VTE) in cancer patients is higher than in the general population. Treatment may also increase this risk in these patients. Based on the appropriate criteria (of which the most important are the current ministerial guidelines) thrombosis prophylaxis should be started (given that there is no contraindication) on these patients and be continued while they are at risk. In the event of permanent risk thrombosis prophylaxis should be given lifelong. The drug of choice is low-molecular-weight heparin (LMWH) which is safer and more effective than the oral vitamin K antagonists. Platelet aggregation inhibitors have proved unsuccessful in this patient group. The evidence so far suggests that LMWH (during VTE prophylaxis) can have a positive impact on the course of cancer and perhaps it will be registered under the indication section for cancer patients in the future.

[Clinical and histopathological results after the neo-adjuvant treatment of advanced rectal tumors]. / Klinikai és hisztopatológiai eredmények elorehaladott rectumtumorok neoadjuváns kezelése után.

The role of the surgical intervention is decisive in treating colorectal tumors. The neo-adjuvant radio-chemotherapy has improved the efficacy of the treatment of advanced rectum tumors. In order to decrease the size and stage of advanced rectal carcinoma and to increase the rate of resecability, we introduced neoadjuvant radio-chemotherapy. We carried out neo-adjuvant and surgical treatment in case of 67 patients with rectal adenocarcinoma (T 2-4 N 1-2 M 0 ) between June 1, 2005 and July 31, 2008. The average age of the patients was 61.2 years, the division according to sex was 44 males/23 females. Regarding the local stage of the rectal process or the proximity to the sphincter, we applied radio-chemotherapy (radiotherapy 25 times altogether 45 Gy and on the first and last week for 5-5 days they received 350 mg/m 2 /day 5-FU and 20 mg/m 2 /day leucovorin chemotherapy, recently complemented with 3 x 1.8 Gy advanced boost radiation aiming at the macroscopic tumor site with security zone). Patients underwent surgery 8 weeks on average after restaging examinations. Thirty-eight patients underwent anterior rectal resection with double stapler procedure; there were 18 abdominoperineal rectal extirpations, 7 Hartmann operations and 4 per annum excisions. Compared to the preoperative staging, the histological evaluation of the resected specimens showed total remission (pT 0 N 0 ) in 11% and partial remission in 43%. The morbidity necessitating reoperation was 5.9%, without mortality and suture insufficiency. The long-term neo-adjuvant oncological treatment led to down-staging of rectal tumors in most cases and increased the resecability and rate of resection operations.