Cancer and pregnancy: a comprehensive review.

BACKGROUND: Pregnancy complicated by cancer is relatively rare but, as women in western societies tend to delay childbearing to the third and fourth decade of life, this phenomenon is going to be encountered more often in the future. MATERIAL AND METHODS: Review of the literature and description of the different diagnostic and therapeutic approaches which are required to diagnose and treat pregnant mothers with cancer. RESULTS: As in non-pregnant patients, every effort should be made to provide the maximal benefit and best prognosis to the pregnant patient. In most cases, in order to avoid any harm to the fetus, different diagnostic approach should be incorporated and treatment should be tailored to each pregnant woman. Cooperation of multidisciplinary teams, incorporating medical and radiation oncologists, surgeons, obstetricians, neonatologists and experienced nursing staff, is required to provide optimal care for the patient. The benefits from use of surgery, chemotherapy and/or radiotherapy as well as the mother's wishes and beliefs need to be factored into recommendations and treatment planning. CONCLUSIONS: With the experience gained, the developments in clinical and radiation oncology and the cooperation of multidisciplinary teams, treatment of cancer during pregnancy with normal fetal outcome is feasible.

Positive urinary cytology in patients with lung cancer in the absence of obvious urine tract metastases.

PURPOSE: To study the phenomenon of positive urine cytology in patients with lung cancer in the absence of obvious urothelial metastases. PATIENTS AND METHODS: 150 patients with small (SCLC) and non-small cell lung cancer (NSCLC) of all stages and 3 control groups were prospectively studied. Immunocytochemical study (cytokeratins 7-20, TTF1) in all positive urine specimens and chemokine profile (CXCR4, CCL21) study of the primary tumor in selected positive patients was performed. In experimental study, C57Bl/6 BALB/C mice injected with LLC lung and 4T1 mammary cancer cells were used for the detection of positive urine cytology. RESULTS: 11% of patients with NSCLC, 7% of patients with SCLC and none of the control group had positive urine cytology. In NSCLC, metastatic disease and high tumor burden positively correlated (p=0.01 and 0.03 respectively) with the phenomenon. In SCLC, correlation with extensive disease and multiple metastatic sites (p=0.02 and 0.04 respectively) was found. No correlation was found in either group with: age, gender, histology, performance status, line of chemotherapy, previous platinum-based chemotherapy, adrenal metastases, renal function, abnormal urinary sediment, response to chemotherapy and overall survival (p=0.9). Distinctive chemokine expression was identified in positive patients studied and was not observed in negative patients (×2 p=0.008). In the experimental study, only the LLC lung cancer cells were detected in the urine cytology of mice. CONCLUSION: This phenomenon, carrying undefined pathophysiological mechanisms, seems to characterize only patients with metastatic/extensive disease and high tumor burden. Further studies are needed to validate our preliminary chemokine expression results.

Disseminated intravascular coagulation (DIC) and non-small cell lung cancer (NSCLC): report of a case and review of the literature.

The clinical manifestation of disseminated intravascular coagulation (DIC) as paraneoplastic phenomenon is common in patients with lung cancer (especially in those with non small cell lung cancer).Surprisingly, only few data have been published on the prevalence of this phenomenon. Herein we present the case of a patient with metastatic giant-cell carcinoma of the lung complicated by DIC leading the patient to death. We also review the literature regarding the incidence, the pathogenesis and the therapy of DIC in NSCLC. As more effective therapy for lung cancer becomes available and patients live longer, DIC can be expected to be encountered more frequently. Because of this fact clinicians should be alert to the occurrence of such clotting disorders and should be familiar with their diagnosis and management.

Susceptibility to autoxidation of lipids of paroxysmal nocturnal hemoglobinuria (PNH)-like red cells.

The susceptibility to autoxidation of red cell lipids was studied before and after transformation of normal red cells to PNH-like erythrocytes. The transformation was effected by treatment of the red cells with the sulfydryl compounds D-penicillamine (DP) and N-acetyl-L-cysteine (NAC). The autoxidation was induced by incubating the cells with H2O2 and was estimated by measuring the generated malonyl dialdehyde. The susceptibility to autoxidation was significantly higher in DP-treated cells, while the opposite was true for NAC-treated cells. However, both DP- and NAC-treated cells showed a similar sensitivity to lysis by acid serum and about the same degree of acetylcholinesterase (AChE) activity decrease, thus indicating that the susceptibility to autoxidation of lipids is not involved in the determination of complement sensitivity or in the AChE activity decrease of the sulfydryl-treated cells. Finally, since, as evidenced from most of the reported cases in the literature, increased susceptibility to autoxidation is a feature of PNH cells, it seems reasonable to suggest that DP-treated cells should be used in preference to NAC-treated cells as a laboratory substitute for PNH cells.