The article presents the new approaches to the adjuvant medical treatment for breast cancer based on its molecular biological classification.
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Objective. The study of clinical and genetic associations of tumors in patients with multiple primary malignant neoplasms of the reproductive system and colon aimed to increase effectiveness of an early diagnosis, treatment and prevention of these diseases.
Materials and Methods. Health records of 581 patients with multiple primary malignant neoplasms of the colon and reproductive system who underwent treatment at the clinical departments of the Federal State Budgetary Institution «N.N. Blokhin Cancer Research Center» of the Russian Academy of Medical Sciences and of their relatives were studied. Clinical, epidemiological, clinical-genealogical, cytogenetic, molecular genetic research methods were used for the analysis.
Results. The study of patients with multiple primary malignant neoplasms and their genealogical data suggests that polyneoplasia can be one of the manifestations of various hereditary syndromes (syndrome of familial adenomatosis of the colon, Lynch syndrome etc.). The risk of developing malignancies significantly increases in the presence of congenital defects of mismatch repair system. Mutations in mismatch repair genes (MSH2, MLH1 and MSH6) were detected in patients with multiple primary malignant tumors of the colon and reproductive system in 13 (37%) observations.
Five-year survival rate for patients with stage III colon cancer who had underwent preventive panhysterectomy was 83,3% that is considerably higher compared with the same index both for patients with stage III colon cancer who hadn’t had panhysterectomy (69,3%) and for patients with colon cancer who had metachronous metastases in the ovaries (42%) (p.0,01).
Conclusions:
1. It is relevant to perform genetic testing with the aim to detect mutations in the genes MSH2, MLH1, MSH6 in the families of patients with multiple primary malignant neoplasms of the colon, endometrium and/or ovaries, as well as when many cases of solitary tumors of above mentioned localization occurred in one family. For this purpose it is appropriate to start DNA-testing in patients with multiple primary malignant neoplasms, which include such types as colon cancer and endometrial cancer, from detecting the mutations in gene MSH6.
2. Carriers of mutations in genes of mismatch repair system MSH2, MLH1, MSH6 must be classi.ed as a group having high risk for developing such types of malignancies as multiple primary malignant neoplasms of the colon and the organs of female reproductive system and solitary tumors of the above mentioned localizations.
3. All women with colorectal cancer, especially in cases where mutations in genes of mismatch repair system are present, should undergo simultaneous preventive surgery during pre- and menopause periods: hysterosalpingo-oophorectomy. The decision regarding the greater omentum should be based on each particular situation.
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The clinical lecture addresses the issues regarding planning of the standard treatment for malignant trophoblastic tumors.
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Anorexia-cachexia syndrome represents paraneoplastic symptom complex characterized by loss of appetite, body mass loss, decrease of adipose tissue and skeletal muscle mass. Malnutrition significantly affects quality of life and the results of anti-cancer therapy. The purpose of nutritional support is to prevent or offset eating disorders. The literature review presented here focuses on nutritional support of cancer patients.
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Objective. The objective of the study was to compare technical specifications and operational characteristics of different types of vena cavafilters used to prevent pulmonary thromboembolism (PTE) in cancer patients. Also the study aimed to evaluate the vena cava filter «Crown» characteristics and to determine what indications and contraindications for the .lter use in cancer patients exist.
Materials and Methods. From 2003 to 2012 vena cava filters were implanted in 805 patients who underwent treatment at different clinical departments of the Federal State Budgetary Institution «N.N. Blokhin Cancer Research Center» of the Russian Academy of Medical Sciences in order to prevent pulmonary thromboembolism.
Results. As our research studies determined, only 2 patients (0,24%) of 805 who had received vena cava filter «Crown», developed pulmonary thromboembolism (PTE). Moreover, in these two cases mechanism of pulmonary thromboembolism (PTE) was not associated with inadequate functioning of vena cava filter. In the first case pulmonary thromboembolism (PTE) occurred on a background of disseminated intravascular coagulation (DIC) syndrome and inadequate anticoagulation therapy, while in the second case - vena cava filter was implanted in a patient who had developed sepsis. There were no other significant complications revealed after such interventional procedures.
Conclusions. Therefore, indications for vena cava filter placement in the inferior vena cava (with the choice of its model type «Crown») in cancer patients must be substantially widened: 1) for any form of acute lower extremity and pelvic deep vein thrombosis with existing pulmonary thromboembolism or without it; 2) for chronic post-thrombotic process in lower extremity and pelvic deep veins if a patient is to undergo surgical, chemotherapy or radiation treatment. During abdominal surgery on the upper part of abdomen it is preferable to perform an intra-operative plication of inferior vena cava.
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Ageing is a complex, multifactorial process involving all systems and organs of the body and leading to changes of the immune response. Nowadays population ageing process is a global trend worldwide, the share of older people is growing thus the treatment of cancer in this category of people becomes a topical issue. Biological process of tumor development in patients of this age group differs from the one in patients of young age. But the old age per se cannot be the medical justification to refuse treatment to elderly cancer patients. Before making a decision regarding treatment for cancer in the elderly it is important to assess treatment-related risk factors and to develop an individualized plan of therapy.
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The article presents the experience with the use of Terlipressin (Remestyp) for the prevention of bleeding in surgical procedures for gynecologic cancer.
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