Current Oncology

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Open AccessCase Report

Durable Remission of Inoperable Liver Metastasis from Rectal Cancer after Hepatic Arterial Infusion of Oxaliplatin and 5-Fluorouracil in Combination with Intravenous Cetuximab

by K. Van Bael, M. Aerts, M. de Ridder, J. de Gréve, G. Delvaux and B. Neyns

Curr. Oncol. 2011, 18(5), 256-259; https://doi.org/10.3747/co.v18i5.789 - 1 Oct 2011

Cited by 1 | Viewed by 480

Abstract

At diagnosis of a cT3N0M1 adenocarcinoma of the rectum with synchronous inoperable liver metastases, a 59-year-old man was treated with preoperative radiotherapy (5×5 Gy), followed by laparoscopy-assisted anterior resection of the rectum with total mesorectal excision. At the first postoperative evaluation, a new [...] Read more.

At diagnosis of a cT3N0M1 adenocarcinoma of the rectum with synchronous inoperable liver metastases, a 59-year-old man was treated with preoperative radiotherapy (5×5 Gy), followed by laparoscopy-assisted anterior resection of the rectum with total mesorectal excision. At the first postoperative evaluation, a new lung metastasis was detected. First-line chemotherapy with folfiri (5-fluorouracil, irinotecan, leucovorin) resulted in transient stabilization of the metastatic liver disease. At progression, oxaliplatin and 5-fluorouracil–folinic acid were administered by intrahepatic arterial infusion, in combination with intravenous cetuximab. A partial radiologic response was obtained, with complete metabolic response on fluorodeoxyglucose positron-emission tomography, and normalization of carcinoembryonic antigen values. The solitary lung metastasis was sequentially treated with radiotherapy and resection. Five years after the initial diagnosis, this patient remains free from progression, with residual cystic remnants of the liver metastases visible on conventional computed tomography imaging, but not enhancing with fluorodeoxyglucose positron-emission tomography. Full article

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Open AccessArticle

Canadian College of Medical Geneticists Guidelines for the Indications, Analysis, and Reporting of Cancer Specimens

by A.J. Dawson, J. McGowan–Jordan, J. Chernos, J. Xu, J. Lavoie, J.C. Wang, M. Steinraths and S. Shetty

Curr. Oncol. 2011, 18(5), 250-255; https://doi.org/10.3747/co.v18i5.775 - 1 Oct 2011

Cited by 7 | Viewed by 725

Abstract

The Canadian College of Medical Geneticists (ccmg) is a national organization of medical and laboratory geneticists. The mission of the ccmg is to establish and maintain high-quality professional and ethical standards for medical genetics services in Canada and to help to [...] Read more.

The Canadian College of Medical Geneticists (ccmg) is a national organization of medical and laboratory geneticists. The mission of the ccmg is to establish and maintain high-quality professional and ethical standards for medical genetics services in Canada and to help to ensure that service of the highest quality is delivered to the Canadian public. Cancer cytogenetics is one of the sections of practice of the ccmg. The ccmg Cytogenetic Committee has, therefore, put forward guidelines to provide oncologists and ccmg cytogeneticists with a comprehensive review of the cytogenetic diagnostic tests that are recommended as a minimum standard of care for tumours of hematopoietic and lymphoid tissues and for tumours of soft tissue and bone. The guidelines were approved by the ccmg board of directors in June 2010. Full article

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Open AccessArticle

Establishing a Multicentre Clinical Research Network: Lessons Learned

by N.A. Hagen, C.R. Stiles, P.D. Biondo, G.G. Cummings, R.L. Fainsinger, D.E. Moulin, J.L. Pereira and R. Spice

Curr. Oncol. 2011, 18(5), 243-249; https://doi.org/10.3747/co.v18i5.814 - 1 Oct 2011

Cited by 17 | Viewed by 911

Abstract

Background: Within many health care disciplines, research networks have emerged to connect researchers who are physically separated, to facilitate sharing of expertise and resources, and to exchange valuable skills. A multicentre research network committed to studying difficult cancer pain problems was launched [...] Read more.

Background: Within many health care disciplines, research networks have emerged to connect researchers who are physically separated, to facilitate sharing of expertise and resources, and to exchange valuable skills. A multicentre research network committed to studying difficult cancer pain problems was launched in 2004 as part of a Canadian initiative to increase palliative and end-of-life care research capacity. Funding was received for 5 years to support network activities. Methods: Mid-way through the 5-year granting period, an external review panel provided a formal mid-grant evaluation. Concurrently, an internal evaluation of the network by survey of its members was conducted. Based on feedback from both evaluations and on a review of the literature, we identified several components believed to be relevant to the development of a successful clinical cancer research network. Results: These common elements of successful clinical cancer research networks were identified: shared vision, formal governance policies and terms of reference, infrastructure support, regular and effective communication, an accountability framework, a succession planning strategy to address membership change over time, multiple strategies to engage network members, regular review of goals and timelines, and a balance between structure and creativity. Conclusions: In establishing and conducting a multi-year, multicentre clinical cancer research network, network members were led to reflect on the factors that contributed most to the achievement of network goals. Several specific factors were identified that seemed to be highly relevant in promoting success. These observations are presented to foster further discussion on the successful design and operation of research networks. Full article

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Open AccessArticle

The Role of Transglutaminases in the Pathophysiology of Prostate Cancer

by Richard J. Ablin and Wen G. Jiang

Curr. Oncol. 2011, 18(5), 241-242; https://doi.org/10.3747/co.v18i5.853 - 1 Oct 2011

Viewed by 446

Abstract

Quantification of the enzymatic activity of macromolecules has been a longstanding adjunctive approach in the diagnosis and prognosis of a variety of diseases, including cancer.[...] Full article

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Open AccessArticle

Survival and Treatment Patterns in Elderly Patients with Advanced Non-Small-Cell Lung Cancer in Manitoba

by C.L. Baunemann Ott, N. Ratna, R. Prayag, Z. Nugent, K. Badiani and S. Navaratnam

Curr. Oncol. 2011, 18(5), 238-242; https://doi.org/10.3747/co.v18i5.780 - 1 Oct 2011

Cited by 8 | Viewed by 447

Abstract

Lung cancer is the leading cause of cancer death worldwide. Non-small-cell lung cancer (nsclc) is the most common form of lung cancer, with a median age at diagnosis of 70 years. These elderly patients are often underrepresented in the randomized clinical [...] Read more.

Lung cancer is the leading cause of cancer death worldwide. Non-small-cell lung cancer (nsclc) is the most common form of lung cancer, with a median age at diagnosis of 70 years. These elderly patients are often underrepresented in the randomized clinical trials upon which chemotherapy plans are based. The objective of the present study was to determine the patterns of treatment and survival in elderly patients with advanced nsclc in Manitoba. An eligible cohort of elderly patients over 70 years of age at diagnosis (n = 497) with advanced nsclc was identified from the provincial cancer registry database for the period 2001–2004. Of the 497 patients identified, only 147 had been evaluated by a medical oncologist, and 82 of the 147 had received chemotherapy treatment, which is 16.5% of the initial cohort. Patients who received chemotherapy were younger than those who did not receive chemotherapy. Most patients receiving chemotherapy (84%) received doublet chemotherapy, with an almost equal split between cisplatin and carboplatin treatment. The median survival times for patients in this cohort were 64 weeks (stage iii nsclc) and 56 weeks (stage iv) with chemotherapy treatment, and 46 weeks (stage iii) and 26 weeks (stage iv) without chemotherapy. Although 50% of patients with advanced nsclc are more than 70 years of age, few are evaluated by a medical oncologist and even fewer are treated with chemotherapy. However, it should be noted that, in the elderly patients who were treated, survival times are comparable to those experienced by younger patients, which is indicative of a benefit of chemotherapy treatment for those elderly patients. Full article

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Open AccessArticle

Multidisciplinary Canadian consensus recommendations for the management and treatment of hepatocellular carcinoma

by M. Sherman, K. Burak, J. Maroun, P. Metrakos, J.J. Knox, R.P. Myers, M. Guindi, G. Porter, J.R. Kachura, P. Rasuli, S. Gill, P. Ghali, P. Chaudhury, J. Siddiqui, D. Valenti, A. Weiss and R. Wong

Curr. Oncol. 2011, 18(5), 228-240; https://doi.org/10.3747/co.v18i5.952 - 1 Oct 2011

Cited by 50 | Viewed by 1622

Abstract

Globally, hepatocellular carcinoma (hcc) is the third most common cause of death from cancer, after lung and stomach cancer. The incidence of hcc in Canada is increasing and is expected to continue to increase over the next decade. Given the high mortality rate [...] Read more.

Globally, hepatocellular carcinoma (hcc) is the third most common cause of death from cancer, after lung and stomach cancer. The incidence of hcc in Canada is increasing and is expected to continue to increase over the next decade. Given the high mortality rate associated with hcc, steps are required to mitigate the impact of the disease. To address this challenging situation, a panel of 17 hcc experts, representing gastroenterologists, hepatologists, hepatobiliary surgeons, medical oncologists, pathologists, and radiologists from across Canada, convened to provide a framework that, using an evidence-based approach, will assist clinicians in optimizing the management and treatment of hcc. The recommendations, summarized here, were developed based on a rigorous methodology in a pre-specified process that was overseen by the steering committee. Specific topics were identified by the steering committee and delegated to a group of content experts within the expert panel, who then systematically reviewed the literature on that topic and drafted the related content and recommendations. The set of recommendations for each topic were reviewed and assigned a level of evidence and grade according to the levels of evidence set out by the Centre for Evidence-based Medicine, Oxford, United Kingdom. Agreement on the level of evidence for each recommendation was achieved by consensus. Consensus was defined as agreement by a two-thirds majority of the 17 members of the expert panel. Recommendations were subject to iterative review and modification by the expert panel until consensus could be achieved. Full article

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Open AccessArticle

Health Care Strategies to Promote Earlier Presentation of Symptomatic Breast Cancer: Perspectives of Women and Family Physicians

by R. Heisey, M. Clemons, L. Granek, K. Fergus, S. Hum, B. Lord, D.R. McCready and B. Fitzgerald

Curr. Oncol. 2011, 18(5), 227-237; https://doi.org/10.3747/co.v18i5.869 - 1 Oct 2011

Cited by 19 | Viewed by 787

Abstract

Background: Many women with symptoms suggestive of a breast cancer diagnosis delay presentation to their family physician. Although factors associated with delay have been well described, there is a paucity of data on strategies to mitigate delay. Objectives: We conducted a qualitative research [...] Read more.

Background: Many women with symptoms suggestive of a breast cancer diagnosis delay presentation to their family physician. Although factors associated with delay have been well described, there is a paucity of data on strategies to mitigate delay. Objectives: We conducted a qualitative research project to examine factors related to delay and to identify health care system changes that might encourage earlier presentation. Methods: Individual semi-structured interviews were conducted with women who sought care 12 weeks or more after self-detection of breast cancer symptoms and with family physicians whose practices included patients meeting that criterion. Results: The women and physicians both suggested a need for clearer screening mammography guidelines for women 40–49 years of age and for better messaging concerning breast awareness. The use of additional hopeful testimonials from breast cancer survivors were suggested to help dispel the notion of cancer as a “death sentence.” Educational initiatives were proposed, aimed at both increasing awareness of “non-lump” breast cancer symptoms and advising women that a previous benign diagnosis does not ensure that future symptoms are not cancer. Women wanted empathic nonjudgmental access to care. Improved methods to track compliance with screening mammography and with periodic health exams and access to a rapid diagnostic process were suggested. Conclusions: A list of “at-risk situations for delay” in diagnosis of breast cancer was developed for physicians to assist in identifying women who might delay. Health care system changes actionable both at the health policy level and in the family physician’s office were identified to encourage earlier presentation of women with symptomatic breast cancer. Full article

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Open AccessArticle

Hyperbaric Oxygen Therapy for Late Radiation Tissue Injury in Gynecologic Malignancies

by P. Craighead, M. A. Shea–Budgell, J. Nation, R. Esmail, A. W. Evans, M. Parliament, T. K. Oliver and N. A. Hagen

Curr. Oncol. 2011, 18(5), 220-227; https://doi.org/10.3747/co.v18i5.767 - 1 Oct 2011

Cited by 41 | Viewed by 1306

Abstract

Background: Late radiation tissue injury is a serious complication of radiotherapy for patients with gynecologic malignancies. Strategies for managing pain and other clinical features have limited efficacy; however, hyperbaric oxygen therapy (HBO2) may be an effective option for some patients. Methods: In a [...] Read more.

Background: Late radiation tissue injury is a serious complication of radiotherapy for patients with gynecologic malignancies. Strategies for managing pain and other clinical features have limited efficacy; however, hyperbaric oxygen therapy (HBO2) may be an effective option for some patients. Methods: In a systematic review of the literature, the Ovid medline, embase, Cochrane Library, National Guidelines Clearinghouse, and Canadian Medical Association Infobase databases were searched to June 2009 for clinical practice guidelines, systematic reviews, randomized controlled trials, or other relevant evidence. Studies that did not evaluate soft tissue necrosis, cystitis, proctitis, bone necrosis, and other complications were excluded. Results: Two randomized trials, eleven nonrandomized studies, and five supporting documents comprise the evidence base. In addition, information on the harms and safety of treatment with HBO2 were reported in three additional sources. There is modest direct evidence and emerging indirect evidence that the use of HBO2 is broadly effective for late radiation tissue injury of the pelvis in women treated for gynecologic malignancies. Conclusions: Based on the evidence and expert consensus opinion, (1) HBO2 is likely effective for late radiation tissue injury of the pelvis, with demonstrated efficacy specifically for radiation damage to the anus and rectum; (2) the main indication for HBO2 therapy in gynecologic oncology is in the management of otherwise refractory chronic radiation injury; (3) HBO2 may provide symptomatic benefit in certain clinical settings (for example, cystitis, soft-tissue necrosis, and osteonecrosis); (4) and HBO2 may reduce the complications of gynecologic surgery in patients undergoing surgical removal of necrosis. Full article

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Open AccessArticle

Caring for Survivors of Breast Cancer: Perspective of the Primary Care Physician

by S.L. Smith, E.S. Wai, C. Alexander and S. Singh–Carlson

Curr. Oncol. 2011, 18(5), 218-226; https://doi.org/10.3747/co.v18i5.793 - 1 Oct 2011

Cited by 38 | Viewed by 756

Abstract

Background and Objectives: Increasing numbers of women are surviving breast cancer, and survivorship care is becoming more complex. Primary care physicians provide care for most survivors of breast cancer in the Canadian province of British Columbia. The present study offers insight into [...] Read more.

Background and Objectives: Increasing numbers of women are surviving breast cancer, and survivorship care is becoming more complex. Primary care physicians provide care for most survivors of breast cancer in the Canadian province of British Columbia. The present study offers insight into the confidence of primary care physicians in their abilities to provide such care. It also explores potential ways to assist those providers in enhancing this aspect of their practice. Methods: A questionnaire was mailed to 1000 primary care physicians caring for survivors of breast cancer. The questionnaire explored the perspectives of the responding physicians on their ability to manage various aspects of survivorship care for breast cancer patients, identified preferences for the content and format of communication from oncologists at the time of transition from active oncology treatment to survivorship, and determined the means most commonly used to obtain knowledge about breast cancer. This 1-page, 31-item checkbox and open-answer questionnaire assessed the perceptions of primary care physicians about the care of breast cancer survivors after completion of active treatment and their personal preferences for resources providing information about breast cancer. Results: The questionnaire response rate was 59%. Primary care physicians reported being most confident in screening for recurrence and managing patient anxiety; they were least confident in managing lymphedema and providing psychosocial counselling. Compared with physicians following fewer survivors of breast cancer, those who followed more breast cancer survivors had higher confidence in managing the biomedical aspects of follow-up and in providing counselling about nutrition and exercise. Most physicians found discharge letters from oncologists to be useful. Point-form discharge information was preferred by 43%; detailed description, by 19%; and both formats, by 38%. The most useful information items identified for inclusion in a discharge letter were a diagnosis and treatment summary and the recommended surveillance and endocrine therapy. Continuing medical education events and online resources were the means most commonly used to obtain knowledge about breast cancer. Conclusions: Primary care physicians who provide follow-up for survivors of breast cancer report that they are confident in managing care and satisfied with discharge letters containing a diagnosis and treatment summary, and recommendations for surveillance and endocrine treatment. At the time of patient discharge, additional information about common medical and psychosocial issues in this patient population would be useful to primary care physicians. Preferred means to access current breast cancer information include continuing medical education events and online resources. Full article

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Open AccessLetter

Saccharin Deemed “Not Hazardous” in United States and Abroad

by Louis Z.G. Touyz

Curr. Oncol. 2011, 18(5), 213-214; https://doi.org/10.3747/co.v18i5.836 - 1 Oct 2011

Cited by 5 | Viewed by 865

Abstract

Banned in 1981, saccharin has long been considered carcinogenic because it produced bladder tumours in rats. Saccharin is now unbanned, with more than 100 countries worldwide legitimately allowing saccharin as a food sweetening additive[...] Full article

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Open AccessEditorial

Hyperbaric Oxygen for Radiation Injury: Is it Indicated?

by J.J. Feldmeier

Curr. Oncol. 2011, 18(5), 211-212; https://doi.org/10.3747/co.v18i5.943 - 1 Oct 2011

Cited by 3 | Viewed by 386

Abstract

The article by Craighead et al. in this issue of Current Oncology presents a systematic review of the use of hyperbaric oxygen (HBO2) to treat delayed pelvic radiation complications in patients with gynecologic cancer.[...] Full article

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Open AccessArticle

Array Comparative Genomic Hybridization and Cytogenetic Analysis in Pediatric Acute Leukemias

by A.J. Dawson, R. Yanofsky, R. Vallente, S. Bal, I. Schroedter, L. Liang and S. Mai

Curr. Oncol. 2011, 18(5), 210-217; https://doi.org/10.3747/co.v18i5.770 - 1 Oct 2011

Cited by 8 | Viewed by 606

Abstract

Most patients with acute lymphocytic leukemia (all) are reported to have acquired chromosomal abnormalities in their leukemic bone marrow cells. Many established chromosome rearrangements have been described, and their associations with specific clinical, biologic, and prognostic features are well defined. However, [...] Read more.

Most patients with acute lymphocytic leukemia (all) are reported to have acquired chromosomal abnormalities in their leukemic bone marrow cells. Many established chromosome rearrangements have been described, and their associations with specific clinical, biologic, and prognostic features are well defined. However, approximately 30% of pediatric and 50% of adult patients with all do not have cytogenetic abnormalities of clinical significance. Despite significant improvements in outcome for pediatric all, therapy fails in approximately 25% of patients, and these failures often occur unpredictably in patients with a favorable prognosis and “good” cytogenetics at diagnosis. It is well known that karyotype analysis in hematologic malignancies, although genome-wide, is limited because of altered cell kinetics (mitotic rate), a propensity of leukemic blasts to undergo apoptosis in culture, overgrowth by normal cells, and chromosomes of poor quality in the abnormal clone. Array comparative genomic hybridization (acgh— “microarray”) has a greatly increased genomic resolution over classical cytogenetics. Cytogenetic microarray, which uses genomic dna, is a powerful tool in the analysis of unbalanced chromosome rearrangements, such as copy number gains and losses, and it is the method of choice when the mitotic index is low and the quality of metaphases is suboptimal. The copy number profile obtained by microarray is often called a “molecular karyotype.” In the present study, microarray was applied to 9 retrospective cases of pediatric all either with initial high-risk features or with at least 1 relapse. The conventional karyotype was compared to the “molecular karyotype” to assess abnormalities as interpreted by classical cytogenetics. Not only were previously undetected chromosome losses and gains identified by microarray, but several karyotypes interpreted by classical cytogenetics were shown to be discordant with the microarray results. The complementary use of microarray and conventional cytogenetics would allow for more sensitive, comprehensive, and accurate analysis of the underlying genetic profile, with concomitant improvement in prognosis and treatment, not only for pediatric all, but for neoplastic disorders in general. Full article

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Open AccessArticle

Distress—The 6th Vital Sign

by D. Howell and K. Olsen

Curr. Oncol. 2011, 18(5), 208-210; https://doi.org/10.3747/co.v18i5.790 - 1 Oct 2011

Cited by 64 | Viewed by 839

Abstract

Distress is a common concern across the cancer trajectory, beginning at diagnosis and extending to the post-treatment phase of cancer and long term [...] Full article

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Open AccessEditorial

A Legal Right to Die: Responding to Slippery Slope and Abuse Arguments

by D. Benatar

Curr. Oncol. 2011, 18(5), 206-207; https://doi.org/10.3747/co.v18i5.923 - 1 Oct 2011

Cited by 12 | Viewed by 2676

Abstract

To be forced to continue living a life that one deems intolerable when there are doctors who are willing either to end one’s life or to assist one in ending one’s own life, is an unspeakable violation of an individual’s freedom to live—and [...] Read more.

To be forced to continue living a life that one deems intolerable when there are doctors who are willing either to end one’s life or to assist one in ending one’s own life, is an unspeakable violation of an individual’s freedom to live—and to die—as he or she sees fit.[...] Full article

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Open AccessEditorial

Early-Onset Breast Cancer: What do We Know about the Risk Factors?

by S.A. Narod

Curr. Oncol. 2011, 18(5), 204-205; https://doi.org/10.3747/co.v18i5.938 - 1 Oct 2011

Cited by 10 | Viewed by 397

Abstract

If a woman develops invasive breast cancer in the left breast at age 30, the probability of her developing breast cancer in the right breast by age 40 is about 5% (0.5% per year)¹.[...] Full article

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Open AccessEditorial

Introducing Countercurrents—A New Feature of Current Oncology

by W.D. Foulkes

Curr. Oncol. 2011, 18(5), 203; https://doi.org/10.3747/co.v18i5.947 - 1 Oct 2011

Viewed by 356

Abstract

This issue of Current Oncology contains a new editorial feature that we are calling “Countercurrents.” In this invited series of short pieces, we hope to challenge some of the received wisdom in oncology. These editorials will be written by Dr. Steven Narod, Professor [...] Read more.

This issue of Current Oncology contains a new editorial feature that we are calling “Countercurrents.” In this invited series of short pieces, we hope to challenge some of the received wisdom in oncology. These editorials will be written by Dr. Steven Narod, Professor of Medicine at the Dalla Lana School of Public Health, University of Toronto, who is based at Women’s College Research Institute.[...] Full article

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Open AccessArticle

Current Oncology receives its first journal impact factor

by Current Oncology Editorial Office

Curr. Oncol. 2011, 18(5), 202; https://doi.org/10.3747/co.v18i5.966 - 1 Oct 2011

Viewed by 405

Abstract

Recently, Current Oncology received its first journal impact factor of 1.820, and ranking of 129 out of 184, as published in the 2010 Journal Citation Reports, Science Edition (Thomson Reuters, 2011). [...] Full article

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Curr. Oncol., Volume 18, Issue 5 (October 2011) – 17 articles

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