RESUMO
Colorectal cancer (CRC) is one of the most common tumours worldwide, and 70% of CRC patients are over 65 years of age. However, the scientific evidence available for these patients is poor, as they are underrepresented in clinical trials. Therefore, a group of experts from the Oncogeriatrics Section of the Spanish Society of Medical Oncology (SEOM), the Spanish Cooperative Group for the Treatment of Digestive Tumours, (TTD) and the Multidisciplinary Spanish Group of Digestive Cancer (GEMCAD) have reviewed the scientific evidence available in older patients with CRC. This group of experts recommends a multidisciplinary approach and geriatric assessment (GA) before making a therapeutic decision because GA predicts the risk of toxicity and survival and helps to individualize treatment. In addition, elderly patients with localized CRC should undergo standard cancer resection, preferably laparoscopically. The indication for adjuvant chemotherapy (CT) should be considered based on the potential benefit, the risk of recurrence, the life expectancy and patient comorbidities. When the disease is metastatic, the possibility of radical treatment with surgery, radiofrequency (RF) or stereotactic body radiation therapy (SBRT) should be considered. The efficacy of palliative CT is similar to that seen in younger patients, but elderly patients are at increased risk of toxicity. Clinical trials should be conducted with the elderly population and include GAs and specific treatment plans.
Assuntos
Neoplasias Colorretais , Humanos , Idoso , Neoplasias Colorretais/tratamento farmacológico , Quimioterapia Adjuvante/efeitos adversosRESUMO
INTRODUCTION: Approximately 5 % of all cancer cases are hereditary. Cancer genetic counseling assesses individual and family risks of cancer, conducts genetic studies, interprets results, and advises patients regarding strategies for prevention and risk reduction. Currently, many networks of hereditary cancer genetic counseling units (HCGCUs) are integrated in the medical oncology services of most Spanish hospitals, which are comprised of multidisciplinary teams and offer high-quality care for the treatment of hereditary cancer. MATERIALS AND METHODS: The Spanish Society of Medical Oncology (SEOM) analyzed key issues involving the integration of HCGCUs into the National Health Service. These included basic compliance issues by these units regarding their operation and organization, as well as prerequisites in quality control thereof. RESULTS: This document describes the specific roles and clinical processes performed in HCGCUs in addition to basic services provided by molecular diagnostic laboratories. It also provides a summary on the coordination of care across different levels for patients and families with hereditary cancers. Finally, this document describes the human and material resources needed for the organization of HCGCUs. CONCLUSIONS: SEOM has been a pioneer in the creation and development of HCGCUs. This paper seeks to ensure high-quality care to individuals and families with inherited susceptibility to cancer in Spain.
Assuntos
Aconselhamento Genético/organização & administração , Neoplasias/diagnóstico , Neoplasias/genética , Detecção Precoce de Câncer , Aconselhamento Genético/métodos , Predisposição Genética para Doença , Humanos , Medição de Risco , Sociedades Médicas , EspanhaRESUMO
Gastric cancer is the major cause of cancer-related deaths worldwide. The majority of them are classified as sporadic, whereas the remaining 10% exhibit familial clustering. Hereditary diffuse gastric cancer (HDGC) syndrome is the most important condition that leads to hereditary gastric cancer. However, other hereditary cancer syndromes, such as hereditary non-polyposis colorectal cancer, familial adenomatous polyposis, Peutz-Jeghers syndrome, Li-Fraumeni syndrome and hereditary breast and ovarian cancer, entail a higher risk compared to the general population for developing this kind of neoplasia. In this review, we describe briefly the most important aspects related to clinical features, molecular biology and strategies for prevention in hereditary gastric associated to different cancer syndromes.
Assuntos
Carcinoma , Síndromes Neoplásicas Hereditárias , Medicina Preventiva/métodos , Neoplasias Gástricas , Polipose Adenomatosa do Colo/genética , Polipose Adenomatosa do Colo/patologia , Polipose Adenomatosa do Colo/terapia , Carcinoma/diagnóstico , Carcinoma/genética , Carcinoma/patologia , Carcinoma/prevenção & controle , Aconselhamento Genético/métodos , Predisposição Genética para Doença , Humanos , Modelos Biológicos , Biologia Molecular/métodos , Síndromes Neoplásicas Hereditárias/diagnóstico , Síndromes Neoplásicas Hereditárias/genética , Síndromes Neoplásicas Hereditárias/patologia , Síndromes Neoplásicas Hereditárias/prevenção & controle , Neoplasias Gástricas/diagnóstico , Neoplasias Gástricas/genética , Neoplasias Gástricas/patologia , Neoplasias Gástricas/prevenção & controleRESUMO
Metastatic carcinoma of the soft tissue is extremely rare compared with bone metastases. An intramuscular mass is often thought to be a primary soft tissue sarcoma because intramuscular metastases are very uncommon. Any painful soft tissue mass occurring in patients with a known history of carcinoma, particularly with extensive peritumoral enhancement associated with central necrosis, is highly suspicious for skeletal muscle metastasis. A needle biopsy is necessary for proper diagnosis. It is very important to make a differential diagnosis between metastasis and primary cancer in these cases. Here we present a review of known evidence.
Assuntos
Carcinoma/patologia , Neoplasias Musculares/secundário , Adulto , Idoso , Idoso de 80 Anos ou mais , Biópsia por Agulha Fina , Carcinoma/diagnóstico , Carcinoma/epidemiologia , Carcinoma/terapia , Diagnóstico Diferencial , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Neoplasias Musculares/diagnóstico , Neoplasias Musculares/epidemiologia , Neoplasias Musculares/terapia , Neoplasias Primárias Desconhecidas/diagnóstico , Neoplasias Primárias Desconhecidas/epidemiologia , Neoplasias Primárias Desconhecidas/patologia , Neoplasias Primárias Desconhecidas/terapiaRESUMO
Colorectal cancer is the first cause of cancer in occidental countries if we consider both male and females tumours. In Spain, 26,000 new cases are diagnosed every year. The possibilities of cure are higher if the tumour is diagnosed early. One of the most important risk factors for colorectal cancer is inheritance. Some hereditary syndromes, such as familial adenomatous polyposis (FAP), increase the risk by almost 100% and at a young age. Other more prevalent syndromes, such Lynch syndrome, increase the risk 10-12 times more than in the general population. This article aims at summarising the most important aspects in hereditary colorectal cancer and to be a useful tool to oncologists who work with these patients and their families.
Assuntos
Polipose Adenomatosa do Colo/diagnóstico , Polipose Adenomatosa do Colo/terapia , Consenso , Algoritmos , Carcinoma/diagnóstico , Carcinoma/genética , Carcinoma/terapia , Quimioprevenção/métodos , Neoplasias Colorretais/diagnóstico , Neoplasias Colorretais/genética , Neoplasias Colorretais/terapia , Feminino , Doenças Genéticas Inatas/diagnóstico , Doenças Genéticas Inatas/terapia , Testes Genéticos , Diretrizes para o Planejamento em Saúde , Humanos , MasculinoRESUMO
INTRODUCTION: Recent studies have identified both the prognostic and predictive utility of determining the number of circulating tumour cells (CTC) in patients with solid cancers. MATERIAL AND METHODS: In the present pilot study we evaluated the ability of two different methods to isolate CTC in combination with two strategies to enumerate CTC from patients with stages II and III surgically treated colorectal cancer (CRC). First, we used two systems for tumour cell enrichment (differential centrifugation and immunomagnetic beads), combined with two methods to enumerate CTC (real-time PCR and fl ow cytometry), to determine the most efficient combination. These experiments were performed in a model system using serial dilutions of HT29 tumour cell lines with lymphocytes. Then, CTC analysis using the technical approach selected before was performed in 109 blood samples from 16 stage II and III CRC patients during chemotherapy treatment and follow-up. RESULTS: Immunomagnetic beads followed by flow cytometry was the most efficient combination (ED=60.53; p=0.5). Two cases out of 16 patients analysed had clinical tumour relapse. In both, we detected a significant increase of CTC five and six months, respectively, before the relapse was clinically evidenced. An increase of CTC was also observed in another case without clinical evidence of relapse. The remaining cases (13) had very few or no detectable CTC and no clinical evidence of relapse (p=0.029). CONCLUSIONS: Changes in CTC numbers during follow-up might predict tumour relapse. Further evaluation of CTC prognostic and predictive value in patients with early CRC is warranted.
Assuntos
Carcinoma/diagnóstico , Neoplasias Colorretais/diagnóstico , Detecção Precoce de Câncer/métodos , Células Neoplásicas Circulantes/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Carcinoma/sangue , Carcinoma/patologia , Contagem de Células , Neoplasias Colorretais/sangue , Neoplasias Colorretais/patologia , Feminino , Seguimentos , Células HT29 , Humanos , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Projetos Piloto , RecidivaRESUMO
Lytic and blastic lesions have been associated to malignant tumours, such as solid cancer (breast cancer, renal cancer, prostate cancer, malignant melanoma or thyroid tumours). Although a mixed pattern with lytic and blastic lesions is due to metastatic tumour, this is not the only possible origin. The following case shows a systematic. This case report shows the number of tests that were made in order to discover the origin of osteolytic and osteoblastic lesions and it is notable that there is not an occult neoplasia on every occasion.
Assuntos
Neoplasias Ósseas/secundário , Mastocitose Sistêmica/diagnóstico , Mastocitose Sistêmica/fisiopatologia , Osteólise/etiologia , Idoso , Anemia/complicações , Dor nas Costas/etiologia , Conservadores da Densidade Óssea/uso terapêutico , Diagnóstico Diferencial , Difosfonatos/uso terapêutico , Feminino , Humanos , Hipertensão/complicações , Imidazóis/uso terapêutico , Fatores Imunológicos/uso terapêutico , Interferon-alfa/uso terapêutico , Imageamento por Ressonância Magnética , Mastocitose Sistêmica/tratamento farmacológico , Osteólise/tratamento farmacológico , Osteoporose/complicações , Osteoporose/tratamento farmacológico , Cintilografia , Ácido ZoledrônicoRESUMO
Pituitary metastases of solid tumours are infrequent, specially as a first manifestation. When they happen, they are usually due to breast or lung cancer and are asymptomatic or produce diabetes insipidus. It is very strange that they produce hormonal deficiency. We present a case report of a bronchogenic adenocarcinoma in a 65-year-old man which began with panhypopituitarism, diabetes insipidus and visual alterations. Magnetic resonance imaging revealed a large sellar mass, with clivus infiltration and invading the right cavernous sinus. The biopsy result was adenocarcinoma metastases from lung cancer.
Assuntos
Adenocarcinoma/complicações , Adenocarcinoma/secundário , Hipopituitarismo/etiologia , Neoplasias Pulmonares/patologia , Neoplasias Hipofisárias/complicações , Neoplasias Hipofisárias/secundário , Idoso , Humanos , MasculinoRESUMO
Neurological paraneoplastic syndromes (NPS) affect only 0.01% of cancer patients, chiefly those affected by lung, breast, ovarian and stomach cancer. They frequently cause major disability and produce limitations in patients' daily activities; the character of the disease is irreversible. Clinical suspicion is fundamental for an early diagnosis and it must be backed up by the specification of certain antibodies both present in blood and in cerebrospinal fluid (CSF). Conventional treatments are very inefficient at the time of treating these disorders; at present, the administration of immunoglobulins, immunosuppressors, chemotherapy agents and corticoids are under study, but so far results are not promising. The aim of this review is to analyze the variety of NPS and describe the findings concerning autoimmunity and treatments used at present.
Assuntos
Síndromes Paraneoplásicas do Sistema Nervoso/diagnóstico , Síndromes Paraneoplásicas do Sistema Nervoso/terapia , Anticorpos Antineoplásicos/sangue , Autoanticorpos/sangue , Doenças Autoimunes do Sistema Nervoso/diagnóstico , Doenças Autoimunes do Sistema Nervoso/etiologia , Doenças Autoimunes do Sistema Nervoso/terapia , Diagnóstico Diferencial , Humanos , Imunoglobulinas Intravenosas/uso terapêutico , Imunossupressores/uso terapêutico , Síndromes Paraneoplásicas do Sistema Nervoso/etiologia , Síndromes Paraneoplásicas do Sistema Nervoso/imunologia , Síndromes Paraneoplásicas do Sistema Nervoso/fisiopatologia , PlasmafereseRESUMO
A multitude of diseases can present as posterior bilateral uveitis. In most cases, the cause of pericardial effusion can be determined, but in some instances, the cause is not apparent even after making a systematic and complete diagnostic evaluation. We report here an unusual case of a patient who had a B-cell lymphochytic lymphoma, which presented as bilateral posterior uveitis. The diagnosis by biopsy is described, as is the role of multiple test in the diagnosis of bilateral uveitis.
Assuntos
Leucemia Linfocítica Crônica de Células B/diagnóstico , Neoplasias Primárias Desconhecidas/diagnóstico , Uveíte Posterior/etiologia , Idoso , Anticorpos Monoclonais/administração & dosagem , Anticorpos Monoclonais Murinos , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Ascite/etiologia , Sedimentação Sanguínea , Ciclofosfamida/administração & dosagem , Doxorrubicina/administração & dosagem , Humanos , Leucemia Linfocítica Crônica de Células B/complicações , Leucemia Linfocítica Crônica de Células B/diagnóstico por imagem , Leucemia Linfocítica Crônica de Células B/tratamento farmacológico , Leucocitose/etiologia , Linfonodos/diagnóstico por imagem , Masculino , Neoplasias Primárias Desconhecidas/diagnóstico por imagem , Neoplasias Primárias Desconhecidas/tratamento farmacológico , Derrame Pleural Maligno/etiologia , Tomografia por Emissão de Pósitrons , Prednisona/administração & dosagem , Rituximab , Uveíte Posterior/sangue , Vincristina/administração & dosagemRESUMO
The majority of deaths due to breast cancer occur in the context of complications secondary to metastatic disease. Trastuzumab, as a second line treatment, has shown a 15% objective response rate in patients with metastatic breast cancer. We present the case of a patient with two breast tumours, the second of more aggressive characteristics, with negative hormone receptors and c-erb-B2 +++, and with few therapeutic options due to her hepatic insufficiency secondary to metastatic disease; she was administered herceptin as monotherapy, and she had a complete clinical response. Trastuzumab has revolutionised the management of patients with metastatic breast cancer and Her-2- neu overexpression. Its combination with chemotherapy agents achieves a synergic activity.
Assuntos
Anticorpos Monoclonais/uso terapêutico , Antineoplásicos/uso terapêutico , Neoplasias da Mama/tratamento farmacológico , Carcinoma Ductal de Mama/tratamento farmacológico , Carcinoma Ductal de Mama/secundário , Neoplasias Hepáticas/tratamento farmacológico , Neoplasias Hepáticas/secundário , Idoso , Anticorpos Monoclonais/administração & dosagem , Anticorpos Monoclonais Humanizados , Antineoplásicos/administração & dosagem , Antineoplásicos Hormonais/administração & dosagem , Antineoplásicos Hormonais/uso terapêutico , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Biópsia , Neoplasias Ósseas/tratamento farmacológico , Neoplasias Ósseas/secundário , Mama/patologia , Neoplasias da Mama/patologia , Neoplasias da Mama/radioterapia , Neoplasias da Mama/cirurgia , Carcinoma Ductal de Mama/patologia , Carcinoma Ductal de Mama/radioterapia , Carcinoma Ductal de Mama/cirurgia , Cisplatino/uso terapêutico , Terapia Combinada , Intervalo Livre de Doença , Feminino , Fluoruracila/uso terapêutico , Seguimentos , Humanos , Avaliação de Estado de Karnofsky , Neoplasias Hepáticas/diagnóstico por imagem , Metástase Linfática , Mastectomia Radical Modificada , Metotrexato/uso terapêutico , Dosagem Radioterapêutica , Receptor ErbB-2 , Tamoxifeno/administração & dosagem , Tamoxifeno/uso terapêutico , Fatores de Tempo , Tomografia Computadorizada por Raios X , Trastuzumab , Resultado do TratamentoRESUMO
Skin metastases as manifestation of internal neoplasias constitute a 0.8% of their initial presentation and generally imply an advanced stage of the disease and a short survival. The lung cancer metastasises to the skin in 2.8-24% of the cases, generally in advanced stages of the disease, although in 7-19%, skin metastases appear as first manifestation thereof. Sometimes, the study of the extent in the patients reveals that there are no metastases at other levels. We hereby present the case of a male diagnosed with a lung cancer whose first manifestation was the appearance of skin metastases.
Assuntos
Neoplasias Pulmonares/patologia , Neoplasias Cutâneas/secundário , Idoso , Humanos , Neoplasias Pulmonares/diagnóstico , MasculinoRESUMO
Small cell lung cancer is the most common cause of paraneoplastic Cushing's syndrome. The definitive treatment consists in surgical removal of the tumour, which is not possible in most of these cases (they are often diagnosed at advanced stages), and therefore it is frequently necessary adding the drug ketoconazol. We hereby present the case of a patient diagnosed with a metastatic carcinoma of unknown origin associated with two paraneoplastic syndromes: a Cushing's syndrome and a sensitive-motor axonal neuropathy, a very uncommon association.
Assuntos
Síndrome de ACTH Ectópico/etiologia , Adenocarcinoma/diagnóstico , Neoplasias Primárias Desconhecidas/diagnóstico , Polineuropatia Paraneoplásica/etiologia , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
The case of a 61-year-old woman who presented a recurrent symptomatic pericardial effusion and a malignant cardiac tamponade six months prior to the detection of a mediastinal anterior mass is described. Diffuse malignant pericardial mesothelioma was diagnosed after mediastinal mass biopsy. The patient underwent further oncological evaluation followed by chemotherapy.
Assuntos
Neoplasias Cardíacas/diagnóstico , Mesotelioma/diagnóstico , Derrame Pericárdico/etiologia , Pericárdio , Idoso , Tamponamento Cardíaco/etiologia , Feminino , Humanos , RecidivaAssuntos
Adenocarcinoma/secundário , Neoplasias da Medula Óssea/secundário , Carcinoma Pulmonar de Células não Pequenas/secundário , Vértebras Cervicais/patologia , Neoplasias Pulmonares/patologia , Neoplasias da Coluna Vertebral/secundário , Vértebras Torácicas/patologia , Adenocarcinoma/tratamento farmacológico , Adenocarcinoma/radioterapia , Adenocarcinoma/cirurgia , Neoplasias da Medula Óssea/tratamento farmacológico , Neoplasias Encefálicas/tratamento farmacológico , Neoplasias Encefálicas/radioterapia , Neoplasias Encefálicas/secundário , Neoplasias Encefálicas/cirurgia , Carcinoma Pulmonar de Células não Pequenas/tratamento farmacológico , Carcinoma Pulmonar de Células não Pequenas/radioterapia , Carcinoma Pulmonar de Células não Pequenas/cirurgia , Cisplatino/administração & dosagem , Terapia Combinada , Irradiação Craniana , Craniotomia , Desoxicitidina/administração & dosagem , Desoxicitidina/análogos & derivados , Docetaxel , Lobo Frontal/patologia , Humanos , Neoplasias Pulmonares/tratamento farmacológico , Masculino , Pessoa de Meia-Idade , Taxoides/administração & dosagem , Vimblastina/administração & dosagem , Vimblastina/análogos & derivados , Vinorelbina , GencitabinaRESUMO
Prognosis in prostate cancer is determined, in greater part, by the presence of metastases. Bone metastases can occur in any part of the skeleton even, for example, at the base of the skull. We present a case of a 78 year old male who, in December 2001, presented with paralysis of the third cranial nerve. The NMR and CAT scans were normal and circulating levels of PSA were elevated. He was referred to the Urology Service where the treatment guidelines included complete androgen block. Subsequently, he developed retro-orbital pain, divergent strabismus and palpebral ptosis. CAT and NMR indicated a soft tissue mass at the sphenoid level. Treatment was Gamma Knife Radio-surgery. Since August 2004, in conjunction with the latest rise in PSA, the patients general status deteriorated considerably and he was referred to the Oncology Service. There was an increase in the paralysis of the third, fourth and sixth cranial nerve (complete left ophthalmoplegia) and left-central facial paralysis. Metastases from prostate cancer can be disseminated via the lymphatic or the blood system. Currently, there are more metastases from large-size tumours. Metastases are critical in prostate cancer because of their adverse effect on the patients survival. Measurements of circulating levels of prostate specific antigen and prostate acid phosphatase are very useful in the clinical diagnosis of the primary tumour, or its metastases.