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Given the potentially fatal consequences of inadequate adherence with oral anticancer treatment in persons with cancer, understanding the determinants of adherence is vital. This paper aims at identifying psychosocial determinants of adherence to oral anticancer treatment. We reviewed the literature on psychosocial determinants of adherence with oral anticancer treatment, based on published literature in English, from 2015 to present. Literature searches were performed in PubMed, Embase, Web of Science, Cochrane library, Emcare, and PsychINFO, with 'cancer', 'medication adherence', 'psychology', and 'oral anticancer treatment' as search terms. The obtained 608 papers were screened by two independent reviewers. In the 25 studies identified, illness perceptions, medication beliefs, health beliefs, and depression were found to be the major psychosocial determinants of adherence to oral anticancer treatment; sociodemographic and clinical characteristics were found to be of no major importance. The quality of the identified studies as assessed by two independent reviewers was found to be acceptable overall. The majority of papers were from North America and focused on patients with breast cancer; sample size varied from 13 to 1371; adherence was assessed with questionnaires derived from various theoretical models, pill counts and electronic pharmacy records; illness perceptions reflecting adaptive coping, and medication beliefs reflecting high necessity and low concerns were found to be associated with adherence. Psychosocial concepts are major determinants of adherence with oral anticancer treatment. 'Beliefs about medicines' and 'illness perceptions' in particular determine adherence with this treatment. Studies aiming at impacting adherence would benefit from interventions with a solid basis in behavioral theory in order to help health care providers explore and address illness perceptions and medication beliefs. Pre-consultation screening of adherence behavior may be a helpful supportive approach to improve adherence. Blaming the victim ('patients should be educated about the importance of adherence') is better replaced by encouraging health professionals to identify and address maladaptive psychosocial determinants of adherence. [ABSTRACT FROM AUTHOR]

Purpose: In this paper, we present age-standardized cancer incidence and mortality rates in the Faroe Islands. We also compare with the Nordic rates and show incidence rate ratios (IRR) and mortality rate ratios (MRR). Materials and methods: The Faroese cancer registry (FCR) was established in 1994, with incidence available from 1960 and mortality from 1983. The FCR is a part of the NORDCAN collaboration, where the different Nordic countries all report anonymized cancer data by standardized methods, ensuring comparability. Validation efforts revealed that 13% of cases had not been reported to the FCR from 2006 to 2019, emphasizing the need for continued validation efforts of cancer registries. After validation, we submitted the updated cancer cases to NORDCAN and now present this data, taken directly from the NORDCAN website (2019 data). Results: We found that the incidence of the summary group all cancers in the Faroe Islands increased from 1960 to 2019, while cancer mortality decreased from 1983 to 2019. Comparisons with Nordic rates showed significantly lower IRRs for cancer in all cancers, bladder and urinary tract, and skin cancer for both sexes, while IRR was lower for breast cancer in women and prostate cancer in men. Contrary, IRR was higher for rectum and kidney cancer in women and esophagus and testicular cancer in men. There was an increased MRR for cancer in female organs, bladder and urinary tract, and kidney cancer in women, and esophagus and pancreas cancer in men. In contrast, malignant hematopoietic diseases and melanoma in women had a lower MRR. Conclusions: Cancer incidence in the Faroe Islands was lower than in the other Nordic countries. Of particular interest, the incidence of testicular cancer saw a steep increase during the last 20 years, and an investigation into possible causes for this is needed. [ABSTRACT FROM AUTHOR]

In clinical practice, the term "paraneoplastic itch" is used to describe itch in patients with cancer. Patients with hematological or solid tumor malignancies can be affected. In general, paraneoplastic itch is considered a rare disorder. However, paraneoplastic itch in hematological malignancies such as polycythemia vera and lymphoma are relatively frequent while other forms of paraneoplastic itch are in fact extremely rare. The true frequency of this symptom is unclear, epidemiological data in this field are limited. Itch in malignant disease may additionally impair patients' quality of life. A population-based cohort study showed that chronic itch without concomitant skin changes is a risk factor for having undiagnosed hematologic and bile duct malignancies. Paraneoplastic itch is rather resistant to treatment. In 2012, an interdisciplinary interest group of physicians and researchers was founded, aiming to generate a clear definition of paraneoplastic itch. In this paper we briefly review the current knowledge and aim to define what can be summarized under the term "paraneoplastic itch". [ABSTRACT FROM AUTHOR]

Background and purpose: Radiotherapy for vulvar carcinoma is challenging due to relatively high risk of locoregional disease recurrence, a technically challenging target, and postoperative lymphocele, and a high risk radiation sequelae. We aim to explore, if it is possible to reduce dose to normal tissue, while maintaining CTV coverage for this patient group with online adaptive radiotherapy. Materials and methods: 20 patients with vulvar carcinoma (527 fractions) were treated with online adaptation on a Varian Ethos accelerator. Setup CBCTs were acquired daily for adaptive planning. Verification CBCTs were acquired immediately prior to dose delivery. CTV dose coverage and dose to bladder and rectum were extracted from the scheduled and adapted plans as well as from adapted plans recalculated based on verification CBCTs. In addition, analysis of the decision of the adaptive procedure was performed for 17 patients (465 fractions). Results: Mean CTV D95% and standard deviation was 98% ± 5% for the scheduled plan compared to 100.0 ± 0.3% and 100.0 ± 0.8% for the adapted plan on the setup and verification CBCT respectively. Dose to OARs varied substantially and did not show any benefit from adaption itself, however a margin reduction was implemented after the first patients treated. The adapted plan was chosen for 63.5% of the fractions and dominant reasons for not adapting were 'no significant dosimetric gain' (75 fractions, 14%) and 'Medical doctor (MD) not available for treatment' (50 fractions, 9.5%). The median adaption time was 15 min and the 25th and 75th percentile was 12 and 17 min, respectively. Conclusion: CTVs and PTVs dose coverage were significantly improved with adaptation compared to image-guided RT. This gain was robust during the treatment time. [ABSTRACT FROM AUTHOR]

Introduction: Professional visual artists constitute a heterogeneous vocational group, including, but not limited to painters, photographers, textile artists, and sculptors who may face exposure to workplace hazardous substances and lifestyle factors that may contribute to the development of selected cancers. The objective of this registry-based cohort study was to assess the cancer incidence among Nordic visual artists. Materials and methods: This study is based on data from the Nordic Occupational Cancer (NOCCA) project that combines census data of 15 million people from all Nordic countries and cancer registries from 1961 to 2005. For the present study we selected a cohort of visual artists from Finland, Iceland, Norway, and Sweden. Standardized incidence ratio (SIR) analyses were conducted with the cancer incidence rates for the entire national study populations used as reference rates. Results: In male visual artists, there were statistically significant excesses in cancers of the tongue (SIR 2.91, 95% confidence interval 1.74-4.55), oral cavity (2.09, 1.26-3.27), pharynx (2.18, 1.45--3.15), testis (1.91, 1.11-3.05), renal pelvis (2.48, 1.42-4.03) and bladder (1.33, 1.14-1.55). The risk was significantly decreased for cancers of the lip (0.45, 0.18-0.93) and stomach (0.65, 0.50-0.84). In female visual artists, the only significantly increased risk was observed for breast cancer (1.29, 1.13-1.48) and the only significantly decreased risk for stomach cancer (0.43, 0.17-0.88). The incidence of lung cancer was close to the population average in both sexes. Conclusions: The non-elevated incidence of lung cancer suggests a similar prevalence of smoking between visual artists and the general population, while the elevated risk of cancers of mouth and pharynx among male visual artists is suggestive of more widespread alcohol drinking. The excess risk of urogenital cancers might be associated with exposure to solvents. NOVELTY & IMPACT The exposure of visual artists to carcinogens remains unstudied and equivocal. The current study suggests that visual artists carry an overall cancer risk that is slightly above the risk among the general population of the four Nordic countries. We observed in men over two-fold excess risks of cancers of the tongue, oral cavity, pharynx, and renal pelvis, and also a significant risk of testis and bladder cancers. [ABSTRACT FROM AUTHOR]

Symptoms of posttraumatic stress disorder (PTSD) and adjustment disorder (AjD) are common in hematological cancer patients as they face severe stressors during their serious disease and often intensive treatment, such as stem cell transplantation (SCT). Aims of the present study were to provide frequency and risk factors for PTSD and AjD based on updated diagnostic criteria that are lacking to date. In a cross-sectional study, hematological cancer patients were assessed for stressor-related symptoms via validated self-report questionnaires based on updated criteria for PTSD (PCL-5) and AjD (ADMN-20). Frequency and symptom severity were estimated among the total sample and SCT subgroups (allogeneic, autologous, no SCT). SCT subgroups were compared using Chi-squared-tests and ANOVAs. Linear regression models investigated sociodemographic and medical factors associated with symptomatology. In total, 291 patients were included (response rate: 58%). 26 (9.3%), 66 (23.7%) and 40 (14.2%) patients met criteria for cancer-related PTSD, subthreshold PTSD and AjD, respectively. Symptom severity and frequency of criteria-based PTSD and AjD did not differ between SCT subgroups (all p > 0.05). Factors associated with elevated symptomatology were younger age (PTSD: p < 0.001; AjD: p = 0.02), physical comorbidity (PTSD: p < 0.001; AjD: p < 0.001) and active disease (PTSD: p = 0.12; AjD: p = 0.03). Based on new criteria, a considerable part of hematological cancer patients reports PTSD and AjD symptoms. Younger patients and patients with physical symptom burden might be particularly at risk and need to be monitored closely to enable effective treatment at an early stage. [ABSTRACT FROM AUTHOR]

Background. In 2009, the European Randomized Study of Screening for Prostate Cancer (ERSPC) was one of two studies to report interim data on the effect of screening for prostate cancer (PC) on the disease specific mortality. Contradictory results caused considerable discussion and misunderstanding in secondary literature. Methods. This document is based on a non systematic review of recent evidence for and against screening for PC, specifically considering three recently published randomized screening trials [1--3]. Results. The ERSPC data are based on a core age group of 162 387 men, aged 55--69 years, who were identified through population registries in seven European countries. Men were randomized between a screening group that received screening at an average of once every four years and a control group. After a median follow-up of nine years, a reduction in the rate of death from PC by 20% was shown which increased to 31% after adjusting for non-compliance and contamination. Overdetection and subsequent overtreatment (with a number needed to treat (NNT) of 48) are considered to be the major down sides of screening. The recently published 14-year results have shown that these down sides strongly depend on the duration of follow-up. In response to the outcomes of the ERSPC, several points of discussion have been brought up by various authors concerning the usefulness of screening considering benefits, harms and costs, the methodology of the ERSPC and the interpretation of its outcomes. Important issues to address regarding PC screening are addressed. Conclusions. This paper sheds a light on the controversial points of the ERSPC as well as on the priority issues of PC screening. On July 2, 2010 the Swedish section of ERSPC (Gööteborg screening trial) published their results with a median follow-up of 14 years. With longer follow-up the data confirm the trend seen in improvement of PC mortality and suggest much more favorable future outcomes also with respect to the NNT to prevent one PC death. [ABSTRACT FROM AUTHOR]

The article summarizes research on prostate cancer which was contained in papers which were presented at the World Health Organization's International Consultation on Prostate Cancer. In the article the author offers his opinions on the research and on the changing relationship between physicians and increasingly informed patients with prostate cancer.

Cancers of major and minor salivary glands represent a histopathologic challenge in two major respects. The first challenge is the complexity of morphologic features and overlapping of histologic patterns in the different tumor entities many of which are relatively rare. The number of separate tumor entities to be considered in differential diagnosis has greatly increased in the two latest WHO classification systems 1, 2 (Table I). The second challenge is prognostication based on histopathology. The clinical experience is that behavior of some salivary gland carcinomas does not correlate well with their histopathologic classification, and that tumors classified within the same category may exhibit quite different clinical outcomes. However, recent advances in histopathological classification have been combined with new tools in immunohistochemical diagnosis and prognostication including cell-proliferation markers, myoepithelial antigens, matrix metalloproteinases, steroid receptors, growth factors and their receptors. These have improved our possibilities for more specific choices in the treatment of a variety of salivary gland carcinomas. This paper will give an overview on recent developments in histopathological classification, prognostication, and molecular pathology of salivary gland cancer. [ABSTRACT FROM AUTHOR]

A monogenic inheritance, mainly seen as a dominant pattern, accounts for 5-10% of all cancer cases. The increased knowledge and identification of high-risk genes have led to a need for specialized cancer family clinic was the expression used by Eeles and Murday. The Oncogenetic Clinic at the University Hospital in Lund was started in 1993 and the authors' 10-year experience is summarized in this paper. The clinic offers service to the South Swedish Health Care Region comprising a total of 1.6 million inhabitants. During these first 10 years a total of 1 059 individuals from 789 families have been individually counselled. The most common reason for referral was a family history of breast cancer, followed by a family history of colorectal cancer. According to the commonly used criteria, 437 (55%) of the families were considered as autosomal dominantly inherited; 147 families (19%) did not fulfil these criteria but had a strong clustering of breast/ovarian or colorectal/endometrial cancer. The remaining 205 families (26%) were not recognized as any previously described hereditary cancer syndrome with early onset. However, most of these families had a family history of cancer. Mutation analysis was performed in 386/789 (49%) of the families. In families with breast and ovarian cancer a genetic aberration was identified in 45/76 (59%) and in breast-only families in 27/129 (21%). In MSI-positive colon cancer families 16/34 (47%) of the families had a germline mutation. Thus, the majority of the families referred to the clinic were in obvious need of genetic counselling concerning cancer and heredity and in a substantial number of the families a germline mutation could be identified. [ABSTRACT FROM AUTHOR]

Squamous cell carcinoma of the head and neck is a devastating illness with a severe impact on affected individuals. Several mechanisms may lead to oxidative stress in tumor-bearing patients, among others chronic inflammation. Inflammatory cells, especially macrophages and neutrophil leukocytes, may produce reactive oxygen species (ROS) which participate in carcinogenesis and tumor-associated immunosuppression. The aim of the study presented in this paper was to compare the production of reactive oxygen species (ROS)—superoxide anion (O2-) and hydrogen peroxide (H2O2)—by neutrophils isolated from the blood of 16 patients with larynx carcinoma and 15 healthy controls. The serum activity of superoxide dismutase and catalase as well as the total peroxidase activity in serum have also been estimated. The production of ROS, especially spontaneous and phorbol 12-myristate 13-acetate (PMA)-induced O2-, was relatively higher in the patients with larynx carcinoma than in the healthy controls and increased parallel with the tumor stage (tumor, node, metastasis—TNM staging). The serum activity of catalase and peroxidase was also highest in the patients with stage T3 and T4 larynx carcinoma. After partial or total laryngectomy, a significant decrease in ROS production and the serum activity of catalase and peroxidase was observed. In contrast, the serum level of superoxide dismutase, which had been low prior to surgery, especially in the patients with advanced tumor stages (T3–T4), increased significantly afterwards. The results indicate the existence of oxidative stress in the blood of patients with larynx carcinoma and its significant decrease after partial or total laryngectomy. [ABSTRACT FROM AUTHOR]

Diagnostic tests are now available that allow genetic testing for several types of cancer. The aim of genetic counseling and testing for cancer is to educate individuals about cancer risk and cancer prevention, which it is hoped will lead to a reduction in morbidity and mortality. However, at this relatively early stage in the development of genetic counseling and testing programs, information is needed on the psychosocial impact of such programs on both the individual counselee and his/her family. This paper reviews the findings obtained during the past decade on the uptake of genetic testing, reasons for undergoing genetic testing, and the impact of genetic counseling and testing on feelings of distress and guilt. Specific attention is paid to experiences with prophylactic mastectomy and oophorectomy and the effectiveness of the uptake of and satisfaction with these risk-reducing procedures. In addition, the possible impact of genetic testing on insurance, work and future plans is discussed. Suggestions are given for translating research findings into psychosocial services and future research efforts. [ABSTRACT FROM AUTHOR]

Insulin resistance is a critical cause of metabolic dysfunctions. Metabolic dysfunction is common in patients with cancer and is associated with higher cancer recurrence rates and reduced overall survival. Yet, insulin resistance is rarely considered in the clinic and thus it is uncertain how frequently this condition occurs in patients with cancer. To address this knowledge gap, we performed a systematic review and a meta-analysis guided by the Preferred Items for Systematic Review and Meta-Analyses (PRISMA) statement. We included studies assessing insulin resistance in patients with various cancer diagnoses, using the gold-standard hyperinsulinemic–euglycemic clamp method. Studies eligible for inclusion were as follows: (1) included cancer patients older than 18 years of age; (2) included an age-matched control group consisting of individuals without cancer or other types of neoplasms; (3) measured insulin sensitivity using the hyperinsulinemic–euglycemic clamp method. We searched the databases MEDLINE, Embase, and Cochrane Central Register of Controlled Trials for articles published from database inception through March 2023 with no language restriction, supplemented by backward and forward citation searching. Bias was assessed using funnel plot. Fifteen studies satisfied the criteria. The mean insulin-stimulated rate of glucose disposal (Rd) was 7.5 mg/kg/min in control subjects (n = 154), and 4.7 mg/kg/min in patients with a cancer diagnosis (n = 187). Thus, the Rd mean difference was −2.61 mg/kg/min [95% confidence interval, −3.04; −2.19], p<.01). Heterogeneity among the included studies was insignificant (p=.24). These findings suggest that patients with a cancer diagnosis are markedly insulin resistant. As metabolic dysfunction in patients with cancer associates with increased recurrence and reduced overall survival, future studies should address if ameliorating insulin resistance in this population can improve these outcomes thereby improving patient care. Metabolic dysfunction increases cancer recurrence rates and reduces survival for patients with cancer. Insulin resistance is a critical cause of metabolic dysfunctions. To date, no comprehensive compilation of research investigating insulin resistance in cancer patients has been produced. In this meta-analysis, we found that patients with various cancers were markedly insulin-resistant. [ABSTRACT FROM AUTHOR]

The article focuses on a novel technique for resolving large bone defects using two internal lengthening nails (ILNs), one antegrade and one retrograde, aligned in a custom-made tube. Topics include the planning and technique for the bone defect resolution, the reconstructive surgeries involving initial implantation and removal of the tumor, and the associated costs and considerations for the procedure such as the use of a rapid distractor tool and the exchange nailing process.

The net effect of menopausal hormone therapy on the risk of death is understudied, and current evidence is conflicting. Our aim was to investigate the association between menopausal hormones and risk of all-cause, cardiovascular, and cancer-specific mortality, based on the Swedish Prescribed Drug Registry and National Patient Registry. This Swedish population-based matched cohort study included all women, 40 years or older, who had received at least one prescription of systemic menopausal hormone therapy between 2005–2014 (n = 290,186), group level matched 1:3 to non-users (n = 870,165). Multivariable conditional logistic regression models estimated the relative risk of all-cause and cause-specific mortality, adjusting for several clinical factors and comorbidities. Ever-use of menopausal hormones was associated with a slightly lower overall odds of all-cause (OR = 0.97, 95%CI 0.95–0.98) and cardiovascular (OR = 0.97, 95%CI 0.95–0.99) mortality, whilst 30% lower overall odds of cancer-related mortality (OR = 0.70, 95%CI 0.68–0.72) was shown. The odds of all-cause and cancer-related mortality were consistently reduced among women who began menopausal hormone therapy ≤60 years, whereas the association with cardiovascular mortality was inconsistent. In contrast, oestrogen-only therapy was associated with elevated odds of all-cause (OR = 1.14, 95%CI 1.11–1.16) and cardiovascular mortality (OR = 1.04, 95%CI 1.01–1.06) among women who began treatment at ≥70 years. Among current users, oestrogen-only therapy was associated with higher odds of all-cause (OR = 1.48, 95%CI 1.44–1.52) and cardiovascular mortality (OR = 1.24, 95%CI 1.20–1.28), whereas past use of oestrogen-only therapy suggested lower odds of mortality. Our generalisable data suggest that early menopausal hormone treatment initiation does not increase the odds of mortality. However, the role of oestrogens in particularly cardiovascular mortality remains to be investigated. [ABSTRACT FROM AUTHOR]

Altered miRNA expressions are assigned pathogenic properties in several cancers including mycosis fungoides and could play a role in the early onset of the disease. The aim of this study was to examine disease-specific miRNA expression in early-stage mycosis fungoides patch and plaque lesions. A quantitative real-time PCR platform of 384 human miRNAs was used to study miRNA expression in 154 diagnostic mycosis fungoides biopsies. A total of 110 miRNAs were significantly differentially expressed (>2-fold, p < 0.05) between plaque lesions and healthy controls, and 90 miRNAs (>2-fold, p < 0.05) differed between patch lesions and healthy controls. Moreover, 13 miRNAs differed in expression between patch and plaque lesions. Early-stage mycosis fungoides exhibited miRNA features that overlapped with those of psoriasis. However, 39 miRNAs, including miR-142-3p, miR-150 and miR-146b, were specific to mycosis fungoides. In conclusion, early-stage mycosis fungoides expresses a distinct miRNA profile, indicating that miRNAs could play a role in the early development of mycosis fungoides. [ABSTRACT FROM AUTHOR]

Cancer-related fatigue is one of the most prevalent and distressing symptoms among cancer patients, resulting in a great cancer research challenge. Numerous systematic reviews of physical training interventions have been conducted to find the most effective approach. However, evidence remains fragmented, and in which cancer population physical training is more effective than other populations is still unclear. Thus, this study critically appraised systematic reviews and meta-analyses on physical training to reduce adults' cancer-related fatigue. A systematic review of systematic reviews and meta-analysis (PROSPERO: CRD42020189049), assessing the efficacy of exercise training for reducing cancer-related fatigue in adults, was conducted in PubMed, CINAHL, Cochrane Database of Systematic Reviews, and the Database of Abstracts of Reviews of Effects, and Pedro. The selected studies (standardized mean difference, SMD; 95%CI), was quantitatively pooled using a random-effects model. Heterogeneity was tested using chi-squared (Q) and I-square statistics (I2). Of 1438 identified articles, 11 met the inclusion criteria, and ten were meta-analyzed. The results yielded a positive effect of physical training on fatigue in all cancer populations, SMD = −0.33 (−0.43, −0.23). Subgroup analysis based on tumor localization showed a slightly higher physical training effect on fatigue in adults with breast cancer, SMD = −0.36 (−0.57, −0.15), and prostate cancer SMD = −0.34 (−0.45, −.0.22). Our analysis demonstrated some potential improvement in cancer-related fatigue in adult patients undergoing physical training during and after cancer treatments, particularly in patients with breast or prostate cancer. [ABSTRACT FROM AUTHOR]

There is increasing evidence that the inactivated influenza vaccine contains immunostimulatory properties that favor cytotoxicity and benefit survival in large population-based studies. This study aimed to determine whether an influenza vaccine was associated with risk of recurrence, overall mortality, and disease-free survival in patients undergoing curative surgery for colorectal cancer. We performed a register-based study based in Denmark in the period 2009–2015. The primary outcome was a risk of recurrence, while the secondary outcomes were overall mortality and disease-free survival. A total of 9869 patients were included, with 5146 patients receiving an influenza vaccine between one year before and six months after surgery. In a multivariate Cox regression model, there was no association with risk of recurrence (HR 0.94, 95% CI 0.85–1.05), overall mortality (HR 0.95, 95% CI 0.87–1.03), and disease-free survival (HR 1.01, 95% CI 0.94–1.09). In patients receiving the vaccine between six and twelve months before surgery, we found an association to decreased risk of recurrence (HR 0.78, 95% CI 0.67–0.91) but no association with overall mortality (HR 1.04, 95% CI 0.93–1.17) or disease-free survival (HR 0.97, 95% CI 0.88–1.07). Subgroup analysis of patients revealed contradictory results. We believe that this study's findings support the need for further clinical studies to investigate the causal effects of the influenza vaccine on oncological outcomes. [ABSTRACT FROM AUTHOR]

Human papillomavirus (HPV) is an established prognostic marker in oropharyngeal squamous cell carcinoma. Currently, the role of HPV in sinonasal carcinoma is being explored. This systematic review addresses the role of HPV in sinonasal cancer, establishing the occurrence of HPV-positive cancers and the influence of HPV-positivity on prognosis in sinonasal cancer as well as the utility of the putative surrogate marker of HPV (p16) in sinonasal cancer. Studies were identified with searches of Medline via PubMed and Embase via OVID (4 May 2020). Articles on original research concerning sinonasal cancer and HPV in humans written in English were included. Case reports with less than five cases were excluded. Initially, 545 articles were identified; 190 duplicate articles were removed leaving 355 articles for title/abstract screening. Title/abstract screening excluded 243 articles, leaving 112 studies assessed for eligibility. After full-text screening, 57 studies were included. All articles investigated the significance of HPV in sinonasal carcinomas. HPV was reported in approximately 30% of sinonasal squamous cell carcinoma (SNSCC), where it was associated with a better prognosis. In sinonasal cancer, p16 is associated with diagnostic pitfalls and a putative utility of p16 in SNSCC has yet to be established. HPV was not frequently reported in other types of sinonasal carcinomas, besides the recently described subtype, HPV-dependent Multiphenotypic Sinonasal Carcinoma. In other types of sinonasal carcinoma, HPV is not frequently found. Approximately 30% of SNSCC are HPV-positive. HPV-positivity in SNSCC is associated with improved survival. HPV occurs only rarely in other sinonasal cancers. There is currently not sufficient evidence for p16 as a surrogate marker of HPV in SNSCC. [ABSTRACT FROM AUTHOR]

Infertility is a well-known sequela of cancer treatment. Despite guidelines recommending early discussions about risk of fertility impairment and fertility preservation options, not all patients of reproductive age receive such information. This study aimed to investigate young adult cancer patients' receipt of fertility-related information and use of fertility preservation, and to identify sociodemographic and clinical factors associated with receipt of information. A population-based cross-sectional survey study was conducted with 1010 young adults with cancer in Sweden (response rate 67%). The inclusion criteria were: a previous diagnosis of breast cancer, cervical cancer, ovarian cancer, brain tumor, lymphoma or testicular cancer between 2016 and 2017, at an age between 18 and 39 years. Data were analyzed using logistic regression models. A majority of men (81%) and women (78%) reported having received information about the potential impact of cancer/treatment on their fertility. A higher percentage of men than women reported being informed about fertility preservation (84% men vs. 40% women, p <.001) and using gamete or gonadal cryopreservation (71% men vs. 15% women, p <.001). Patients with brain tumors and patients without a pretreatment desire for children were less likely to report being informed about potential impact on their fertility and about fertility preservation. In addition, being born outside Sweden was negatively associated with reported receipt of information about impact of cancer treatment on fertility. Among women, older age (>35 years), non-heterosexuality and being a parent were additional factors negatively associated with reported receipt of information about fertility preservation. There is room for improvement in the equal provision of information about fertility issues to young adult cancer patients. [ABSTRACT FROM AUTHOR]

Cancer patients are vulnerable to infections, are older and often have comorbidities in comparison to the general population, which increases the risk for severe outcomes related to COVID-19 diagnosis. This study is a prospective, nationwide study in patients with solid cancer and SARS-CoV-2 infection included between 10 March to 15 June 2020. Patient's baseline characteristics were collected. The study's primary outcome was overall survival within 30 days of verified SARS-CoV-2 infection. Secondary outcomes were hospital admission, admission to an ICU, and need for supplemental oxygen. A total of 112 patients with a cancer diagnosis and verified SARS-CoV-2 infection were identified. After one month of follow up, hospitalization was required for 54% (n = 61) and 21% of the patients had died and 14 of the 23 deceased cancer patients were ≥70 years. Most patients were classified with mild COVID-19 symptoms (66%, n = 74); however, 48% (n = 23) of the ≥70-year-olds patients were classified with severe or critical COVID-19 symptoms. Among the total study population, 61% (n = 68) had comorbidities and comorbidity were more frequently observed among the deceased (91%, n = 21) and older cancer patients (≥70 years, 81%, n = 39). Acknowledging the low sample size in this study, our work shows that age and comorbidities, but not recent cytotoxic therapy, are associated with adverse outcomes of SARS-CoV-2 infection for patients with solid cancer. Particularly, patients with progressive disease seem to be at greater risk of a fatal outcome from COVID-19. Age, performance status, and comorbidities are strong predictors of adverse outcome in cancer patients with SARS-CoV-2 infection. Patients with progressive cancer disease seem to be at greater risk of a fatal outcome from COVID-19. Recent cytotoxic therapy, however, did not seem to be associated with increased risk for adverse outcomes of SARS-CoV-2 infection for patients with solid cancer. [ABSTRACT FROM AUTHOR]

Anti-transcriptional intermediary factor-1γ (TIF-1γ) autoantibody may be associated with cancer in adult patients with dermatomyositis. The aim of this study was to evaluate the risk of cancer in the presence of anti-TIF-1γ autoantibody in adult dermatomyositis. A comprehensive database search of EMBASE, MEDLINE and the Cochrane Library up to May 2018 was performed using the main key words "dermatomyositis", ""myositis", "inflammatory myopathies" and "anti- TIF-1". Eighteen studies, with a total of 1,962 dermatomyositides, were included in the meta-analysis. The pooled prevalence of cancer-associated dermatomyositis in patients with anti-TIF-1γ autoantibody was 0.41 (95% confidence interval (CI) 0.36-0.45). In the presence of anti-TIF-1γ autoantibody, the overall diagnostic odds ratio of cancer was 9.37 (95% CI 5.37-16.34) with low heterogeneity (Cochran's Q: 14.88 (df = 17, p = 0.604); I2 = 0%). The results of this systematic review confirm that detection of anti-TIF- 1γ autoantibody is a valuable tool to identify a subset of adult dermatomyositis patients with higher risk of cancer. [ABSTRACT FROM AUTHOR]

As for all types of cancer, the incidence of melanoma increases with age. However, naevus counts (the principal risk factor for melanoma) decrease with age; hence the relationship between ageing and melanoma is complex. Subjects who maintain a high naevus count after the age of 50 years are more likely to be affected by melanoma, as their lesions do not senesce. Longer telomere length, which is strongly related to age, is linked to high naevus counts/melanoma risk; thus melanoma biology is influenced by factors that slow down ageing. Age is also an important prognostic factor in melanoma. Increasing age leads to worse survival in stages I, II and III. Sentinel lymph node (SLN) status, which is a strong predictor of melanoma survival, is also affected by age, as SLN positivity decreases with age. However, the prognostic value of SLN on survival increases with age, so, again, these relationships are complex. In patients with stage IV melanoma, age impacts on survival because it affects responses to treatment. This review examines the effects of age on melanoma risk, prognostic factors and responses to treatment. [ABSTRACT FROM AUTHOR]

The introduction of dermoscopy has improved the accuracy of diagnosis of melanoma. However, early stage melanoma can be difficult to diagnose. Eighty-nine cases of thin melanoma with a Breslow thickness ≤1 mm located on the lower limb and diagnosed between 2008 and 2016 were assessed using 4 dermoscopic algorithms: (i) modified pattern analysis; (ii) ABCD rule of dermoscopy; (iii) 7-point checklist; and (iv) Menzies' method. Two groups of early stage melanomas of the legs were identified: "difficult to diagnose melanomas" (DDM) and "non-difficult to diagnose melanomas" (NDDM). In our series the dermoscopic features of DDM were difficult to differentiate from melanocytic naevi, and the reticular pattern was the most frequently observed. "Depigmentation" was the only specific criterion associated with DDM. The sensitivity of diagnostic systems for thin melanomas of the lower limbs was lower than in previous studies. This result could be related to the lower mean Breslow thickness of the invasive melanomas in our sample and the high number of melanomas in situ. In conclusion, early stage melanoma of the legs may be difficult to detect at clinical examination or with dermoscopic examination alone. Focusing on depigmentation in dermoscopy associated with anamnestic features could be a useful tool to detect difficult thin melanomas. In addition, sequential dermoscopy is recommended for high-risk patients with previous melanomas or atypical mole syndrome. [ABSTRACT FROM AUTHOR]

Objective. Previous studies suggest individuals born with oral clefts and their families have a higher susceptibility for cancer, which raises the hypothesis that these two conditions share common molecular pathways. This study evaluated the association between oral clefts and polymorphisms in genes that play a role in craniofacial and tumor development. Materials and methods. Four hundred and ninety-seven subjects born with oral clefts and 823 unaffected subjects were recruited. Twenty-nine markers in 13 genes were genotyped by the Taqman method. Chi-square was used to compare allele and genotype frequencies. Bonferroni correction for multiple testing was used and the established alpha was 0.0003. This study also used logistic regression to test if genetic variants were associated with oral clefts using positive family history of cancer and age as covariates. Results. There was no association between family history of cancer and oral clefts ( p = 0.51). None of the 1320 study participants had a diagnosis of cancer at the time of participation in the study. The marker rs4980700 in FGF3 was associated with oral clefts ( p = 0.0002). Logistic regression analysis also provided evidence for gene-gene interaction between FGF3 (rs4980700) and PAX9 (rs2073242), increasing the risk for isolated oral clefts ( p = 0.0003). Conclusion. FGF3 is associated with oral clefts and may interact with PAX9. [ABSTRACT FROM AUTHOR]

Background. Currently there is no consensus on the use of adjuvant radiotherapy (RT) in retroperitoneal sarcoma (RPS). We have analysed clinical outcomes in patients with localised RPS treated at two Scandinavian Sarcoma Group (SSG) centres: Haukeland University Hospital (HUH), Bergen, Norway and Skåne University Hospital (SUH), Lund, Sweden to clarify the effects of adjuvant RT on local control and overall survival (OS). Material and methods. Local databases and registers at HUH and SUH as well as the SSG central register were used to identify RPS patients. Patients with localised RPS who underwent surgery in Bergen between 1988 and 2009 and in Lund from 1998 to 2009 were included. Medical records were examined for clinical data, tumour characteristics, treatment factors and follow-up status. Archived tumour sections and tumour tissue were reviewed, and when necessary, restained and reclassified. Cox regression was used to analyse the association of potential prognostic factors with local recurrence-free survival (LRFS), metastasis-free survival (MFS) and OS. Results. The study included 97 patients: 52 from Norway and 45 from Sweden. The proportion of high-grade tumours was 73%. The five-year LRFS, MFS and OS were 55%, 59% and 60%, respectively. RT was significantly associated with improved local control resulting in a five-year LRFS of 77% compared with 39% without (p < 0.001). Furthermore, five-year OS was 71% in the RT group in contrast to 52% with surgery alone (p = 0.019). In the adjusted analysis RT proved to be a significant factor also for MFS (HR = 0.42, 95% CI 0.20-0.88, p = 0.021). In addition, high-grade malignancy, large tumour and positive surgical margin were risk factors for local recurrence. High malignancy grade was the only significant adverse prognostic factor for metastasis. High age and high-grade malignancy were negative prognostic factors for OS. Conclusion. Adjuvant RT was significantly associated with an improved five-year LRFS and OS. [ABSTRACT FROM AUTHOR]

The dermoscopic descriptor "negative pigment network" (NPN) has been reported in several types of melanocytic and non-melanocytic lesions, although it has a higher frequency of association with melanoma and Spitz nae-vus. In a study of 401 consecutive melanomas, excluding facial, acral and mucosal locations, the frequency and variability of NPN were investigated, and the results of NPN correlated with clinical and histopathological data. NPN of any extention was found in 27% of melanomas, most frequently invasive and arising from a naevus on the trunk of young subjects. Seven percent of melanomas in the study population showed presence of NPN in more than half of the lesion area; most of these did not show typical dermoscopic melanoma features. The authors propose a new melanoma subtype, in which extensive NPN should be considered per se as a diagnostic indicator. [ABSTRACT FROM AUTHOR]

Objective. Oral lichen planus (OLP) is known to be associated with the risk of developing oral squamous cell carcinoma (OSCC). The objective of this study was to investigate the clinicopathological features of OLP and the prevalence of malignant transformation in this setting. Materials and methods. This retrospective study was carried out on 204 medical records of patients with histologically proven OLP who received long-term follow-up (range 6 months-12 years). Data were entered in an informatic database. The statistical analysis, when needed, was performed with the chi-squared test for significance ( p < 0.05). Results. At the moment of the diagnosis, out of 204 patients (163 female and 41 male; mean age 54.5 years), 107 patients (52.45%) suffered from systemic chronic diseases, in particular 46 (22.5%) from hepatitis C. Clinically, the reticular form of OLP was the predominant one and most patients had multiple oral sites of involvement. Fourteen patients showed extra-oral lesions. A percentage of malignant transformation less than 1% was found. In fact, two patients (0.98%) underwent a malignant transformation at a site previously diagnosed as OLP. Conclusions. At present, OLP is accepted as being a potential malignant disorder, therefore lifelong follow-up is recommended. [ABSTRACT FROM AUTHOR]

Background. Inequality in use of mammography screening across population groups is a concern since migrants are more likely to become non-users compared to the general population. The aim of this study was to a) identify determinants of participation among migrant groups and Danish-born women with emphasis on the effect of household size, socioeconomic position and use of healthcare services, and b) test whether effects of determinants were consistent across migrant and non-migrant groups. Material and methods. We used data from the first eight invitation rounds of the mammography screening programme in Copenhagen, Denmark (1991-2008) in combination with register-based data. Results. The crude odds ratio (OR) for not participating in mammography screening was 1.38 (95% CI, 1.30-1.46) for women born in other-Western and 1.80 (95% CI, 1.71-1.90) for women born in non-Western countries compared to Danish-born women. The adjusted OR was 1.14 (95% CI, 1.06-1.21) for other-Western and 1.19 (95% CI, 1.11-1.27) for women born in non-Western countries. Lack of contact with a general practitioner or dental services, and not being employed had a significant negative effect on use of mammography screening. Higher-educated women were significantly less likely to use mammo-graphy screening in all groups whilst hospitalisation had a significant effect among Danish-born women. Living alone was consistently associated with non-use of mammography screening. The probability of becoming a non-user was significantly less among women living within households of two to four persons compared to women living alone. Except in the case of age and hospitalisation, trends were similar across country of birth, but the relative importance of specific determinants in explaining use of mammography screening differed. Conclusion. Household size, socioeconomic position and use of healthcare services were determinants of participation in mammography screening. This study emphasises the need for conducting refined analyses distinguishing among subgroups within diverse populations when explaining differences in screening behaviour. [ABSTRACT FROM AUTHOR]

Background. The Prostate, Lung, Colorectal and Ovarian Cancer Screening Trial (PLCO) was conducted in sites around USA during a period of marked secular changes in the use of prostate specific antigen (PSA) screening for prostate cancer. Material and methods. Trends in prostate cancer incidence, stage at presentation and mortality are useful when interpreting the results from a screening trial that commenced in 1993 and enrolled participants through 2001. The last participants completed active screening in 2006. Incidence and mortality data published to date on PLCO need to be placed into the context of the secular trends. Additional data analyses have been conducted on subsets of the participants and these results can also enhance the interpretation of the trial. Additionally, the accompanying biospecimen repository has served as a rich research resource yielding informative findings. Results. The PLCO is best viewed as a trial comparing a regimented active annual screening program of PSA screening for six rounds, four of which had accompanying digital rectal examination (DRE) to patterns of screening that were occurring in the population in many academic and community settings across the USA. The epidemiology and molecular genetics of prostate cancer is becoming better understood and analyses of the PLCO resource have contributed. One approach to risk assessment utilizing genetic markers from selected members of the PLCO prostate cancer cohort has been developed. A modeling effort with CISNET-ERSPC-PLCO is underway to compare and contrast findings such as effects of different PSA thresholds and screening intervals. Conclusions. The information emerging from PLCO is useful to inform the debate around prostate cancer screening. An understanding of the biologic differences underpinning indolent and aggressive prostate cancer will better guide the future development of screening and treatment strategies. [ABSTRACT FROM AUTHOR]

Background. Family history of prostate cancer is a risk factor for prostate cancer occurrence. Differently from other neoplasms no major predisposing gene has been identified. Material and methods. This review article presents the controversial results of studies about the prognostic and predictive role of family history in prostate cancer, reports the discovered predisposing genes, and biologic and pathologic findings. Results. Mortality from PC remains a significant health care problem, but no trial investigated if it changed in presence of positive family history. The largest family study yet published concluded that men with family history are diagnosed and die at earlier ages than men without it. However, it failed to stress the prognostic value of family history. Genome-wide association studies of prostate cancer have identified a number of genetic variants at different loci in different populations. Prostate neoplasms of patients with positive family history exhibit a different pattern of expression of genes related with estrogen and androgen metabolism within the tumor. High-penetrance and low-penetrance genes in diagnosis and prognosis of prostate cancer, difficulties to define a classification and to quantify relative risks of single genes, documented gene-environment interactions are discussed. Conclusion. Family history stands for both shared genetic and environmental factors and their interaction. The availability of prostate-specific antigen test could explain partly the high familial risk, among brothers or shortly after the diagnosis of prostate cancer. Polymorphisms in genes associated with prostate cancer probably represent the most part of familial prostate cancer burden. An increasing knowledge of disregulated cellular pathways of lethal prostate cancer could define which of all genetic alterations have a role in defining new preventive and therapeutic strategies. [ABSTRACT FROM AUTHOR]

Material and methods. Based on a five-year follow-up of 130 692 women who participated in the five-yearly organised screening in Finland in 1995, we estimated the risk for incident invasive cervical cancer and severe precancerous lesion for groups of women with different combinations of high-risk determinants at baseline. Results. Compared to women with normal cytology and no symptoms at the index screen, the risk of developing invasive cervical cancer during the next screening interval was significantly elevated in women with abnormal cytology at baseline screen (RR 5.8, 95% CI 2.6-13.1); additionally, the risk of cervical intraepithelial neoplasia grade 3 (CIN3) lesions was even higher (RR 9.4, 95% CI 6.9-12.5), both results after removing respective screen detected cases at index screen. Among women with symptoms of vaginal bleeding or abnormal vaginal discharge but normal cytology the risk of invasive cervical cancer was increased but not significantly (RR 2.4, 95% CI 0.9-6.3) and the risk of CIN3 lesions was only slightly elevated (RR 1.5, 95% CI 0.95-2.4). In women less than 40 years of age, the risk of cervical cancer was 50% higher than in women 40 years or more in those with normal cytology and no symptoms, however not significantly. Symptoms indicated a similarly elevated risk for cancer in both age groups. After abnormal cytology there was a nine-fold risk for cancer in young women (under 40 years) and a six-fold risk in old women (40 years or more) when compared to women aged 40 or more with no symptoms and normal cytology. In young women CIN3 lesions were found in great excess, three times more often, compared to those aged 40 and over. Discussion. In all, selective intensified screening for cervical cancer complementing the five-yearly unselective programme is feasible for women with abnormal cytological findings at an acceptable level of incremental cost. [ABSTRACT FROM AUTHOR]

Introduction. The efficacy of the vascular disrupting agent combretastatin A-4 phosphate (CA4P) depends on several factors including tumor size, nitric oxide level, interstitial fluid pressure, and vascular permeability. These factors vary among tumor types. The aim of this study was to investigate all these factors in two tumor models that respond differently to CA4P. Material and methods. Mice bearing C3H mammary carcinomas or KHT sarcomas (200 to 800 mm3) were intraperitoneally injected with CA4P (100 mg/kg). Tumor size and the effect of a nitric oxide inhibitor nitro-L-arginine (NLA) administered intravenously were evaluated by necrotic fraction histologically assessed at 24 hours. Interstitial fluid pressure (IFP) was measured using the wick-in-needle technique, and vascular characteristics were assessed with dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI). Results. Initial necrotic fraction was about 10% in both tumor models at 200 mm3, but only increased significantly with tumor size in the C3H mammary carcinoma. In this tumor, CA4P significantly induced further necrosis by about 15% at all sizes, but in the KHT tumor, the induced necrotic fraction depended on tumor size. For both tumor types, NLA with CA4P significantly increased necrotic fraction above that for each drug alone. CA4P significantly decreased IFP in all tumors except in the 800 mm3 C3H tumor, which had an initially non-significant lower value. Interstitial volume estimated by DCE-MRI increased in all groups, except the 800 mm3 C3H tumors. DCE-MRI vascular parameters showed different initial characteristics and general significant reductions following CA4P treatment. Conclusions. Both tumor models showed differences in all factors before treatment, and in their response to CA4P. Perfusion and permeability as estimated by DCE-MRI play a central role in the CA4P response, and interstitial volume and IFP seemed related. These factors may be of clinical value in the planning of CA4P treatments. [ABSTRACT FROM AUTHOR]

Background. The aim of the study was to investigate the results of treatment of malignant parotid gland tumours at a single centre during a 56 year period, focusing on tumour control and survival. Patients and methods. At Uppsala University Hospital, Sweden, 144 patients (73 male and 71 female) with parotid cancer were treated between 1948 and 2004. The mean and median ages were 62 and 65 years, respectively (range 16-89 years). Surgery was the primary treatment in 113 (78%) patients followed by radiotherapy in 81. Postoperative radiotherapy in doses of 64-66 Gy, where the intention was curative and delivered with either split course or not, was administered to a majority of patients after 1970. The split-course mode was practised between 1970 and 1989. The median follow-up time was 8.3 years for patients still alive. There were 57 (40%) relapses, of which 40 were local recurrences with 26 inside the treatment volume.Results. The overall 5-year survival was 53%. The majority of tumour-related deaths appeared in the first 3-5 years after diagnosis. Age, co-morbidity, the presence of lymph node metastases, adenoid cystic carcinoma and extent of disease were important for outcome; gender, however, was not. We found no difference in the survival between patients following split course therapy versus continuous fractionation. No difference could be seen in the survival of patients treated in the 1970s versus the 1990s. Conclusions. Age, nodal engagement, a higher T-stage, adenoid cystic carcinoma histopathology, facial palsy and intercurrent disease worsen the outcome of patients, whereas gender does not. Treatment principles at our hospital have been surgery followed by radiotherapy since the early 1970s even though a split course technique was practised during a part of this period. Survival has not improved markedly. Thus, there is scope for improvement for this group of patients. [ABSTRACT FROM AUTHOR]

To explore job strain in Norwegian primary-treated cancer survivors compared to matched controls from the general population. The study has a cross-sectional, matched case-control design. A sample of 417 employed cancer survivors (208 females with breast cancer and 209 males with testicular or prostate cancer) who had been diagnosed 1-5 years prior to the study and were tumor-free rated themselves on the Demands-Control-Support Questionnaire (DCSQ). Their ratings were compared to those of 417 employed controls from the general population, matched with the survivors on time of investigation, gender, age and municipality of living. No differences in job strain were observed between cancer survivors and controls, or between subgroups of survivors, except that female survivors experienced more strain than males. In certain subgroups statistically significant differences on the DCSQ were found: older survivors showed higher scores on demands than their controls, female survivors reported lower control and higher strain than male survivors, and older male survivors felt higher demands than younger ones. However, the effect sizes of these differences were so small (<0.20) that they hardly were relevant for the work situation. In multivariate analyses survivorship versus control status was not significantly associated with any of the DCSQ measures. The job strain of these cancer survivors did not differ in any work relevant way from their controls, and survivorship status was not significantly associated with job strain. A longer follow-up of survivors is necessary in order to draw conclusion about the stability of these findings over time. [ABSTRACT FROM AUTHOR]

Despite a decline in its incidence in the Western world, gastric cancer (GC) remains the fourth most frequent cancer diagnosis worldwide and is, after lung cancer, the second leading cause of death from a malignant disease globally. Based on the published literature, treatment guidelines and reports from international meetings, we here review the current treatment options for GC and discuss insights and perspectives from the latest clinical studies. The management of GC in the early stages of the disease is based on an optimal surgical resection of the primary tumor and the regional lymph nodes. However, less than one third of patients have a resectable disease at diagnosis and among those operated, more than half are not cured by surgery alone, due to a high rate of relapse. Thus, for the majority of patients, systemic cytotoxic therapy, and sometimes radiotherapy, is a treatment option both as an adjunct to surgery and in the palliative setting. Adjuvant chemotherapy offers only a marginal benefit and has not become a standard of care in the West. In North America, adjuvant chemoradiation is broadly used, shown to significantly improve overall survival, albeit with the cost of high toxicity. Furthermore, a recently reported study from the United Kingdom demonstrated a significant disease-free and survival benefit by the use of perioperative combination chemotherapy. Several chemotherapeutic agents have been tested as a palliative therapy in advanced GC including 5-fluorouracil (5-FU), oral pyrimidines, platinum derivatives, anthracyclines, taxanes and camptothecans. It is now accepted that chemotherapy is better than best supportive care only and that 5-FU based combinations are more effective than monotherapy. However, the response rates have generally been moderate and there is no consensus on the optimal combination of cytotoxic agents and the potential role of more recently developed "targeted therapies". [ABSTRACT FROM AUTHOR]

The aim of this study was to assess the set-up uncertainties and the possible CTV-PTV margin reduction when adopting daily IGRT. Further, to identify any intrafraction time trends in the prostate movements to ensure the margin reduction gained from IGRT. Fifteen prostate cancer patients treated with IMRT using daily IG of three implanted fiducial markers were included. The interfraction uncertainties were assessed by statistically evaluating the daily prostate marker displacement. The intrafraction uncertainties were represented by the difference in prostate marker displacement before and after beam delivery. To evaluate any intrafraction time trends, the data points were divided into two groups with respect to time duration and statistically analysed. This study confirmed that daily IG considerably reduces the set-up uncertainties. Our results implied that if IGRT is performed on a daily basis, both systematic and random set-up errors will be reduced to a minimum, leading to a required set-up margin of only 1.5 mm. Results from measurements of intrafraction motions in time durations ranging from 2 to 27 min, indicated that a margin enlargement of 1 mm was required to account for the intrafraction uncertainties. The results did not suggest any significant time trends in the intrafraction uncertainties. [ABSTRACT FROM AUTHOR]

The article reflects on the development of adjuvant therapy for patients with malignant melanoma. The attempts to develop an efficient adjuvant therapy have met with limited success despite the considerable efforts. The attention has focused on the development of adjuvant interferon therapies during the last decade and initial optimism was raised by the report of the ECOG E1684 trial in 1996.

Cancer may arise because the developmental programs that create the dramatic alterations in form and structure in embryonic development are potentially corrupted. The cells in our bodies retain memories of these processes and cancer can occur later in life if imperfections occur in the fidelity of these pathways. This article is particularly interested in the phenomenon of epithelial to mesenchymal transition, which occurs in embryogenesis. Also reviewed are the small molecules and pathways that are involved both in homeostasis in adult epithelium and embryogenesis in utero. There are five such pathways in particular selected for review in this article: the Wnt pathway, Hedgehog, Notch, PAR and Bone morphogenetic peptide/TGF β. These are usually conserved throughout mammalian evolution. Though they have been arbitrarily separated in this article they are not exclusive from one another. Their pathologically altered expression is found especially frequently in childhood tumours where they may recapitulate their developmental role, and in tumours that resemble primitive precursor cells. These pathways are important for selecting cell fates, cellular rearrangements, cytological context and morphologic design in embryology as well as participating in epithelial function in adults. [ABSTRACT FROM AUTHOR]

Endocrine pancreatic tumors are rare with an incidence of 4 per million inhabitants. Most tumors are malignant except for insulinomas that usually are benign. They are slowly growing in the majority of cases but there are exceptions with rapidly progressing malignant carcinomas. Because of the rarity of these tumors large randomized trials are difficult to accomplish. However, most physicians treating these patients agree that surgery should be considered in all cases and that medical treatment with chemotherapy and biotherapy is well established for this group of patients. [ABSTRACT FROM AUTHOR]

A longitudinal study based on a serum sample bank was carried out in Finland to find out the association between biochemical substances and the subsequent risk of cancer. The objective was to evaluate the consistency between means of individually estimated levels of these compounds and levels based on pooling. Levels of alpha-tocopherol, beta-carotene, retinol, retinol-binding protein, and ceruloplasmin were estimated by primary site and sex and partly by age and morphology. The concentrations in pooled samples were consistently lower than the averages of the individual samples. On the basis of individual samples, all the five biochemical compounds had a rather consistent protective effect on the risk of cancers at most primary sites. This protective effect disappeared in the pool analyses, and more than half of exposure contrasts showed an opposite sign. For ceruloplasmin, the effect of pooling was smaller but not negligible. The results of this study emphasize the demand to standardize the collecting, handling, and analysing of samples in serum banks. They are, furthermore, consistent with the hypothesis that pooling of biochemical samples affects the levels of the substances and may affect the conclusions of epidemiological studies on causes of diseases. [ABSTRACT FROM AUTHOR]

The aim of the study reported here was to estimate the economic value of the welfare loss due to prostate cancer pain by estimating the extent to which pain affects health-related quality of life among patients with prostate cancer. The material consisted of a point estimate of health status among men with prostate cancer in a well-defined population of 200 000 males. Clinical data concerning the disease at diagnosis (extracted from patients' records and the Regional Prostate Cancer Registry), and health utility ratings (using EuroQol) were obtained from 1156 males with prostate cancer. A descriptive model showed that optimal treatment that would reduce pain to zero during the whole episode of disease would add on average 0.85 quality-adjusted life years (QALY) to every man with prostate cancer. Based on an estimate of the willingness to pay for a QALY the economic value of this welfare loss due to prostate cancer pain is in the magnitude of t86 600000 per year (€19800000 per million men in Sweden). [ABSTRACT FROM AUTHOR]

Many studies have demonstrated an increase of neutrophils in patients with advanced cancer. However, the possible role of increased neutrophils in various neoplasms studied to date varies considerably. The authors examined the changes in white blood cell counts in patients with peritoneal carcinomatosis. Malonildialdehyde and nitric oxide (NO) plasma and ascitic fluid levels, phagocitic activity and the ability of the polymorphonuclear cells (PMNCs) to produce nitric oxide were also measured. An increase in PMNCs and decrease in lymphocytes was found in cancer patients. Compared with healthy controls, cancer PMNCs showed significant enhancement of phagocytosis. Similarly, pretreatment of healthy PMNCs with crude supernatants from short-term cultures of the peritoneal cells from ascitic fluid of patients with peritoneal carcinomatosis caused marked stimulation of PMNC phagocytosis. In addition, plasma and ascitic fluid nitric oxide levels in cancer patients were significantly higher than those found in control one. Most importantly, it was found that PMNCs from cancer patients release significantly more nitric oxide than corresponding normal controls. Therefore, considering the fact that neutrophils make up more than 50% of total leukocytes, these cells can play one of the most important roles in tumor biology. [ABSTRACT FROM AUTHOR]

The Swedish Family-Cancer Database was expanded to include all Swedes born in 1932 and later (offspring) with their parents, totaling 10.2 million individuals. Cancer cases were retrieved from the Swedish Cancer Registry from the years 1958 to 1998, including over 1 million primary cancers and in situ tumors. Some 10% of offspring diagnosed with cancer lack any parental information. Incidence rates of cancers were similar in the database and in the Cancer Registry to age 70, but at higher ages the rates in the Database were lower, probably because of selection. The familial risk for all types of cancer in offspring was 1.73 when a parent had the same type of cancer. The familial rates were increased for all main cancer sites, except for the upper aerodigestive tract, stomach, liver, pancreas and bone marrow (leukemia). The rates were 7.47 for thyroid, 4.69 for testis, and over 2.00 for melanoma, ovary, prostate, skin, endocrine glands and endometrium. [ABSTRACT FROM AUTHOR]

Presents the status of clinical hyperthermia in Western Europe. Relationship of the effect of hyperthermia to thermal parameters achieved in malignant tumor; Improvement of the clinical outcome of radiation therapy and anticancer drugs; Use of advanced hyperthermia machines .

Examines the role modern radiotherapy in the management of cancer in Scandinavia. Improvement of local tumor control by increasing doses of radiation; Significance of hypoxic modification and overall trial; Implications to radiation oncology and medical practice.

Most histopathological classifications of human cancers include significant numbers of hypoxic cells. There is increasing evidence that, at least in certain types of human solid tumors, there is a positive relationship between the presence of hypoxia and poor outcome after radiation therapy alone or radiation combined with other therapies. Hypoxia appears to be an independent prognostic factor. There is evidence for enhanced malignant progression associated with hypoxia, including locoregional invasion and distant metastases. The presence of hypoxia may negatively affect outcome by induction of radiation resistance by the classical oxygen effect and/or by effects on gene expression and malignant progression, causing more aggressive locoregional and distant disease. It is now clear that hypoxia has the potential to influence expression of genes and activities of associated proteins that regulate growth and tissue homeostasis, resulting in cellular phenotypic heterogeneity. The molecular pathways involved in signaling and regulating changes in gene activities in response to external stresses such as hypoxia are becoming known. Identification of patients with hypoxic tumors will lead to improved selective therapy. [ABSTRACT FROM AUTHOR]

Several abstracts of the theses from Scandinavian Countries are presented which include one on hormonal regulation of growth in human endometrial adenocarcinomas-Role of the p53 gene, another on improvements of SPECT by a new collimator design and simultaneous transmission-emission tomography and on regulation of growth, differentiation and survival of B-chronic lymphocytic leukemia cells.

The article focuses on the mechanisms of cellular response to ionizing radiation which is a major cause of cancer. It states that cellular response is triggered by energy deposition in an event where ionization events and free radicals cause macromolecular damage to the cellular structure. It adds that functional cellular response is indicated by signal production within the pace of the cell cycle. Moreover, it asserts that programmed cellular response cannot be manipulated easily.

Describes a life story which focuses upon the important shift in medical ethics from paternalism to patient autonomy to truth-telling regarding the diagnosis. Benefits of chemotherapy for acute leukemia; Description of the key players and major innovations in early leukemia treatment; Influence of combinations of cytotoxic drugs in increasing the cure rate of acute leukemia.