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Human breast cancers depend on estrogen and/or progesterone for growth, and these effects are mediated through estrogen receptors (ERs) and progesterone receptors (PRs), respectively. The human epidermal growth factor receptor 2 (HER2) gene encodes a member of the epidermal growth factor receptor family of receptor tyrosine kinases, and its amplification with resultant overexpression plays a major role in sustaining multiple pathways in cancer growth. ERs, PRs, and HER2 status are the most important molecular markers in the standard care of all primary and recurrent/metastatic breast cancer patients and play both predictive and prognostic roles. The responsiveness of a tumor to hormone therapy is an important parameter in breast cancer management in both adjuvant and metastatic settings. Only breast cancers with HER2 amplification or overexpression respond to HER2-directed therapies. Hormonal status of the tumor is prognostic for patient outcome and site of metastasis. Hormonal receptor-positive disease represents an indolent and slowly growing tumor with longer time to disease recurrence. HER2 is a poor prognostic factor in the absence of HER2-directed therapies. Assessment of the ER/PR/HER2 status is an essential factor in the evaluation of every newly diagnosed breast cancer, and standardization of the assay methods is crucial. more...

AIM: Patients with cancer die not only from the primary cancer disease, die also from many of reasons like bleeding, thromboembolism and sepsis. We aimed to research death reasons and major factors which affects survival who die from cancer in our clinic.MATERIAL AND METOD: 46 patient ( 34 men and 12 women) are included to our research whom death comfirmed with hospital registers in last two years. Statical analysis practiced with SPSS 18 version (SPSS inc., Chicago, IL)RESULTS: Patients in our assessment were stage 4 cancer in the percentage of %91.3 and %84.4 with III and over performance status in their last hospitalizations. %76.1 of these patients practiced chemotherapy and %41.3 of them had radiotheraphy. %31.4 of patients undergone to surgery. There is no difference in survival of patients regardless to their stages and performance scores although women have a long survival compared with men (p, Amaç: Kanser hastaları, kanser dışında kanama, tromboemboli, sepsis gibi bir çok nedenden dolayı ölürler. Bu çalışmamızda kanserden kaybettiğimiz hastalarımızın ölüm nedenlerini ve sağ kalımlarını etkileyen başlıca faktörleri araştırmak istedik. Hasta ve Yöntem: Çalışmaya iki yıl içinde hastanede ölmüş olduğu dosya kayıtlarından saptanan 34 erkek ve 12 kadın toplam 46 hasta dahil edildi. İstatistik analizi SPSS versiyon 18 (SPSS inc., Chicago, IL) programında yapıldı. Bulgular: Değerlendirmeye alınan hastalarımız son yatışlarında %91.3 oranında evre IV hastalık ve %84.4 oranında performans statüsü (PS) III ve üzerinde idi. Ölen hastaların %76.1'i kemoterapi (KT) ve %41.3'ü radyoterapi (RT) almış idi. Hastalar %31.4 oranında cerrahi geçirmişti. Hastaların sağ kalımları evrelere ve performans skorlarına farksız çıkarken kadın hastalar erkeklere kıyasla daha uzun yaşamışlardır (p more...

It has been reported previously that: (1) normal-breast epithelial cells that are CD24-/44+ express higher levels of stem/progenitor cell-associated genes; (2) cancer cells that have undergone epithelial to mesenchymal transition display CD24-/44+ cell-surface expression, a marker for breast cancer stem cells; (3) loss of E-cadherin is a preliminary step in epithelial to mesenchymal transition; and (4) vimentin is a marker of mesenchymal phenotype. We hypothesized that stem cell subpopulations would be more frequent in metastatic than in primary tumors. Therefore we assessed by immunohistochemical analysis, tissue microarrays containing tissue from primary and associated metastatic breast cancers for expression of CD24, CD44, E-cadherin and vimentin to evaluate candidate cancer-initiating cell populations in breast cancer subtypes and metastatic lesions. The occurrence of CD24-/44+ and CD24+/44- cells did not differ in primary vs matched lymph node or distant and locoregional metastatic lesions; E-cadherin expression was decreased in primary vs lymph node metastases (P=0.018) but not decreased in distant and locoregional metastases relative to primary tumor, whereas vimentin, was more frequently expressed in lymph node and distant and locoregional metastases (P=0.013, P=0.004) than in matched primary cancers. Thus, the frequency of CD24-/44+ cells does not differ in metastases relative to the primary breast cancer but differs by tumor stage and subtype. more...

Recent studies have shown some degrees of discordance in ER, PR and HER-2 immunohistochemical expression between primary and recurrent/metastatic lesions (RML). Analysis was made on 78 patients with MBC whose ER, PR and/or HER-2 status were known both on the tissue samples of primary and RML. Among the RML sites, 29.5% were locoregional, 70.5% were distant metastatic sites. Among 75 patients with known ER expression on both primary and RML, 36% (n = 27) showed discordance on ER expression. Among 72 patients with known PR expression on both primary and RML, 54.2% (n = 39) showed discordance on PR expression. Among 61 patients with known HER-2 expression on both primary and RML, 14.7% (n = 9) showed discordance on HER-2 expression. No differences were observed when we compared patients who have discordant ER and HER-2 status with patients who have concordant results between the primary tumor and paired RML with respect to site of biopsy (locoregional vs distant metastasis) and prior therapies (chemotherapy and endocrine therapy). As these discordant results make changes in treatment decision, a biopsy of the metastatic lesion could be recommended in patients with MBC when feasible. Larger series are needed to identify the potential effect of prior therapies and site of metastasis on discordant results. more...

Hormone and human epidermal growth factor receptor 2 (HER-2) receptors are two important pharmaceutical targets that affect the survival of patients with metastatic breast cancer. Discordance of hormone and HER-2 receptors were reported in a series of studies. Receptor status was reported to change in both directions, yet alteration occurs mostly in the loss of positivity for both receptors. We do not know both the exact mechanism of this process or the contribution rate of technical mistakes; a number of mechanisms might be responsible. Factors suggested include: tumor heterogeneity, clonal selection of tumor cell subpopulations, genetic instability of tumor cells, local or systemic treatments, the time interval between primary tumor and metastasis, receptor status determination techniques, and the site of metastasis.Studies of estrogen, progesterone and HER-2 receptor discordance between primary and metastasis of breast cancer are summarized. Laboratory evaluation of estrogen, progesterone and HER-2 receptors, and possible causes of receptor discordance, are summarized. Literature data are reviewed; the major shortcoming of these studies is that they are mostly retrospective.The reader will read a concise literature review about the studies on estrogen, progesterone and HER-2 receptor discordances between primary and metastasis of breast cancer.We do not know whether the changes in receptor expression account for a true biological phenomenon or may result from inconsistent measurement. However, in light of current data, for the treatment plans that target the receptors, biopsy specimen from the metastatis of breast cancer must also be evaulated for alterations in the receptor status. more...

Krukenberg tumor (KT), mostly originates from gastric cancer, is the metastatic tumor of ovaries accounting for 1-2% of all ovarian cancer. Common presenting symptoms include abdominal pain, distension, and ascites. Rests of the patients have non-specific gastrointestinal symptoms including dyspepsia, weight loss, nausea and vomiting. Gynecologic symptoms such as virilization, menstrual bleeding or irregularity and amenorrhea are much less frequent in the literature cases. Here, we present an unusual case of KT presented with amenorrhea as the sole initial symptom. more...

e19107 Background: In this study, the efficacy and safety of pemetrexed chemotherapy was evaluated retrospectively in patients who were non-responders to or who have demonstrated progression after the first and/or second line treatments in local advanced and metastatic NSCLC. Methods: 175 patients (139 males, 36 females) were assessed in years 2008 – 2012. Patients were given pemetrexed 500 mg/m2, and the ones receiving combined treatment were given pemetrexed 500 mg/m2 and cisplatin 75 mg/m2 once in every 21 days. Supplementary steroid and vitamin treatment were administered to all patients. Age, gender, performance status (PS), stage, single agent or combined administration of treatment, progression-free survival (PFS) and overall (OS) were investigated. Patients were assessed in terms of treatment efficacy and toxicity. Results: Median follow-up period was 6 months (1 - 25), and median age was 55 years (28 - 83). In 82% of patients, PS was 0 – 1. 73% of patients were at stage 4. 71% of the patients received single agent pemetrexed, and 14% received platinum - pemetrexed combination treatment. 93% of patients received pemetrexed treatment as second line. Median 3 cycles of treatment (1 – 12) were administered. In side effect assessment, while side effects (grade 1 – 4) were observed in 62% of the patients, the most frequently observed side effects were anemia (18%) and nausea-vomiting (15%). Febrile neutropenia was detected in 6 patients (3.4%).In assessment of the response, the disease control ratio was 50% (21% partial response, 29% stable disease). 1- and OS rates were respectively 14% and 41%. Median OS was 10 months (SE:1, 95% CI: 7-12) and median PFS was 3 months (SE:1, 95% CI: 2-4). In multivariate analysis, PS of 0 – 1 and response to treatment were found as factors with prognostic significance (p=0.047, p=0.014, respectively). Conclusions: It is observed that chemotherapy regimen containing pemetrexed in NSCLC treatment is a treatment approach, which provides an efficient disease control with a manageable side effect profile, in patients especially with good performance status and with no platinum resistance, who can receive treatment in combination form. more...

We read with great interest the article by Francis et al. ( 1 ) in which they showed that incorporating docetaxel into anthracyclinebased therapy resulted in an improvement in disease-free survival (DFS) in adjuvant treatment of patients with lymph node – positive breast cancer. They also noted that sequential but not concurrent administration of docetaxel appeared to produce better DFS than anthracycline-based chemotherapy. However, patients in the concurrent docetaxel arm received more cyles (nine cyles vs seven cyles) and more athracyclines (cumulative doses of 225 vs 200 mg/m 2 ) than patients in the sequential docetaxel arm. In this study, information about the HER2 status of tumors was also not described. However, a meta-analysis of eight published clinical trials ( 2 ) showed that, among women with HER2-positive breast cancer in the adjuvant setting, anthracycline-based regimens were superior to non – anthracyclinebased regimens in DFS and overall survival. Thus, the HER2 status as well as the administration schedule may contribute to higher DFS observed in the sequential docetaxel arm than in the concurrent docetaxel arm in the Breast International Group 02-98 trial. more...

398 JADA, Vol. 139 http://jada.ada.org April 2008 available data and develop and promote guidelines for oral health care providers in the best interests of our patients. Our survey and Dr. Huber’s letter point to the need for continuing research and development of guidelines in detection, diagnosis, intervention and follow-up of oral premalignant lesions that falls within the scope of dentistry. Joel Epstein Professor and Head Department of Oral Medicine and Diagnostic Sciences College of Dentistry and Director, Interdisciplinary Program in Oral Cancer Prevention, Detection and Treatment Chicago Cancer Center University of Illinois at Chicago more...

Colorectal cancer CRC is the third most common cancer in the world and second most common cause of cancer mortality after lung cancer. Metastasis to the regional lymph nodes are found in 40–70% of cases at the time of resection, with metastasis to more distant sites occurring most frequently in the liver, peritoneal cavity, and lung, followed by the adrenals, ovaries, and bone. it is a rare case for a CRC to metastasis to skin and breast and that indicates advanced disease. In this case we reported a 64-year-old female CRC patient presenting with cervical and intra abdominal lymph nodes metastase a short time after adjuvant chemotherapy treatment and subsequent developing breast and diffuse skin metastase at initial of new cure chemotherapy. Because of skin and breast metastase related to colorectal cancers are so rare we try to inform this case to literature, Kolorektal kanser dünya çapında en sık görülen üçüncü ve akciğer kanserinden sonra en sık ölüme neden olan ikinci malignitedir. Rezeksiyon sırasında hastaların %40-70'inde rejyonel lenf nodu metastazı varken, uzak metastazlar en sık karaciğer, peritoneal kavite ve akciğere, daha nadir olarak da adrenaller, overler ve kemiklere olmaktadır. Bu olguda 64 yaşında kolon kanseri nedeniyle adjuvan kemoterapi alan kadın hastada kısa süre sonra gelişen servikal ve intraabdominal lenf nodu metastazı gelişmesini ve yeni başlanan kemoterapi rejiminden kısa süre sonra meme ve cilt metastazı gelişmesini rapor ettik. Kolorektal kanserlerde meme ve cilt metastazlarının çok nadir olması nedeniyle bu olguyu litaratüre bidirmek istedik more...