Combinatorial chemistry in cancer research

Abstract  Among the different strategies to treat cancer, chemotherapy approaches are the subject of intense research efforts. There is still a high demand for new anticancer drugs exhibiting improved efficiency and selectivity for their use in combined therapy strategies. The high development of molecular and cellular biology tools has made possible the set up of simple in vitro assays, susceptible to automation, thus bringing about the possibility of rapid screening of hundreds of compounds. Chemistry has reacted to this challenge by developing a new technology: combinatorial chemistry. By this procedure large collections of compounds, known as chemical libraries, can be prepared in a rapid and efficient manner. In recent years, combinatorial chemistry has had a great impact on drug discovery programmes addressed to tackling cancer pharmaceutical targets. In this review, the contribution of this technology to the discovery of anticancer drugs that are currently in clinical trials or already in the market is discussed.

Aggressive surgical treatment for T4 gastric cancer

Abstract  Surgical treatment for locally advanced gastric cancer remains controversial, and many still question the benefits of extended resection. The aim of this study was to evaluate the effectiveness of combined resection of the involved organs with regard to survival in patients with gastric cancer. Between 1993 and 2000, among the 1638 patients with gastric cancer who underwent gastrectomy, 82 were found to have evidence of adjacent organ spread at laparotomy. A retrospective analysis of these patients was performed. Curative resections were carried out in 50 patients, whereas noncurative resections were performed in 32 patients. The 5-year survival rate in the group undergoing curative resection was 36.9%. The survival rate in the R0 group was significantly higher than the survival rate for patients undergoing noncurative resections. There was no significant difference in survival rates between patients with pT3 cancer and those with pT4 cancer. Seventy-one patients were pathologically proved to have lymph node metastasis, and the survival rate for patients with a lymph node ratio greater than 0.2 was lower than that in other groups. In multivariate analysis, peritoneal dissemination, lymph node ratio, and histologic findings were the predictors of survival. Patients with T4 gastric carcinoma, even with lymph node metastasis, might have benefited from aggressive surgery with curative intent.

Changes in Cancer-Related Risk Perception and Smoking Across Time in Newly-Diagnosed Cancer Patients

We examine the bidirectional relationships between cancer risk perceptions and smoking behavior among newly diagnosed cancer patients (N=188) during hospitalization for surgical resection, and at three and 12 months subsequently. Those with higher perceptions of risk for developing another cancer at three months were most likely to abstain from smoking by twelve months. Patients were relatively accurate in their cancer risk perceptions, with relapsers and continuous smokers reporting higher levels of risk perceptions at twelve months. Finally, those who quit smoking by 12 months felt at lower risk for developing cancer by 12 months. None of these relationships were significant between baseline and three months. Results indicate that perceived risk of cancer recurrence may be clinically useful in motivating smoking cessation after the acute cancer treatment phase is over. This study justifies an expanded theoretical framework attending to the distinct, prospective influences of illness risk perceptions on health behavior, and of health behavior on illness risk perceptions.

Advances in surgical technique for primary rectal cancer

Abstract  Rectal cancer continues to produce significant morbidity and mortality, with about 41,000 new cases diagnosed per year in the United States. Recent advances in the management of rectal cancer, including the standardization of total mesorectal excision and the increasing application of neoadjuvant chemoradiation, have led to an increase in patients undergoing sphincter preservation and a decrease in the rate of local-regional tumor recurrence. This article reviews the current literature that affects the surgeon’s decisions regarding preoperative staging and operative management of the patient diagnosed with rectal cancer.

EGFR-Targeted Therapies in Colorectal Cancer

The management of colorectal cancer relies heavily on the combination of the pyrimidine analog antimetabolite 5-fluorouracil with the platinum-based drug oxaliplatin or the topoisomerase inhibitor irinotecan. Optimization of dosing and scheduling of these agents to improve response and survival continues to evolve. Meanwhile, the rational targeting of molecular signaling pathways that are involved in the etiology of malignancies is currently one of the most promising strategies in novel anticancer drug development. New classes of drugs that target the epidermal growth factor receptor are among the most clinically advanced molecular-targeted therapies and have shown efficacy in colorectal cancer. The current status of epidermal growth factor receptor-targeted therapeutic agents is reviewed, with emphasis on their role in the management of colorectal cancer.

Advances in cancer pain management

Abstract  Control of malignant pain and related symptoms is paramount to clinical success in caring for cancer patients. To achieve the best quality of life for patients and families, oncologists and palliative care clinicians must work together to understand problems related to psychologic, social, and spiritual pain. Pain is the primary problem targeted for control using the World Health Organization’s (WHO) analgesic ladder. This article focuses on increased knowledge of analgesic action that may enable expansion of the WHO analgesic ladder to fulfill the broader objectives of palliative medicine. We discuss clinical experience with several classes of drugs that are currently used to treat cancer pain: 1) nonsteroidal anti-inflammatory drugs (NSAIDs), with emphasis on cyclooxygenase-2 (COX-2) inhibitors; 2) opioid analgesics, with specific emphasis on methadone and its newly recognized value in cancer pain; 3) ketamine, an antagonist at N-methyl D-aspartate (NMDA) receptors; and 4) bisphosphonates, used for pain resulting from bone metastases. New concepts that compare molecular actions of morphine at excitatory opioid receptors, and methadone at non-opioid receptor systems, are presented to underscore the importance of balancing central nervous system excitatory (anti-analgesic) versus inhibitory (analgesic) influences.

Yeast and Cancer

The discovery of genes that control cell division in yeast, and their relation to cancer, is reviewed.

Advanced testis cancer

Opinion statement  Advanced testis tumors are highly curable. The treatment strategy is chemotherapy followed by the surgical exeresis of residual disease. The standard chemotherapy regimen is BEP (bleomycin, etoposide, and cisplatin); the number of cycles of chemotherapy depends upon prognostic factors, based on the primary site, histology, presence of visceral metastases, and serum tumor marker levels. Patients in the good-risk group receive three cycles of chemotherapy , whereas those in the intermediate- and high-risk groups receive four cycles. Exeresis of all residual disease and systematic postchemotherapy retroperitoneal dissection in bulky disease are mandatory. When complete exeresis of necrotic tissue, teratoma, or active germ-cell cancer has been performed, no further postsurgical treatment is warranted. A multidisciplinary approach, rigorous administration of chemotherapy, and skill in surgery of germ-cell tumors are favored in the treatment of these patients in trained centers.

A Survey of Patients’ Experiences with the Cancer Genetic Counseling Process: Recommendations for Cancer Genetics Programs

In order to promote ongoing quality improvement of not only the Penn State Cancer Genetics Program, but also other cancer risk assessment programs throughout the country, we developed, piloted and conducted a survey to explore patient expectations, experiences, and satisfaction with the cancer genetic counseling process. The comprehensive survey was mailed to 340 eligible patients, 156 (45.9%) of whom returned the completed survey within the allotted time. Responses to closed-ended questions were tallied and open-ended questions were content analyzed. Major findings show that: (1) Patients were seeking cancer-related information and support throughout the cancer risk assessment process and were interested in participating in available research studies; (2) The setting in which patients are seen for cancer risk assessment may pose potential emotional ramifications; (3) Misperceptions regarding insurance discrimination and lack of insurance coverage persist; (4) Patients view the genetic counselor as responsible for updating them about new discoveries. Specific recommendations for cancer genetics programs are included.

Chemoprevention of Colorectal Cancer

Colorectal cancer is a major public health concern in all developed countries. Despite decades of advances in the treatment and prevention of colorectal cancer, it remains the second most common cause of cancer death. However, the optimal method for early detection remains unknown and patient compliance with screening recommendations remains poor. This has led to the development of complementary strategies, such as chemoprevention to reduce morbidity and mortality from colorectal cancer. Chemoprevention is defined as the use of specific pharmacologic or nutrient agents to prevent, reverse, or inhibit the process of carcinogenesis. This review was designed to discuss the most promising agents in colorectal chemoprevention.

Anthropometric Measurements in Male Breast Cancer

Background: 1% of breast cancers occur in men.The etiology is obscure. An elevated BMI has been postulated to be a cause. Methods: All male breast cancer patients operated from January 1990 to May 2001 were retrospectively reviewed. Relation between BMI and male breast cancer was examined. Results: 43 males underwent breast surgery for breast cancer during this period. 3 patients were excluded from the study because of other risk factors for breast cancer.The average BMI of 40 patients was 26.54 kg/m², which is mildly above the level for normal weight. Conclusions: Excessive adipose tissue may increase risk of male breast cancer.

Advanced non-small cell lung cancer

Opinion statement  The treatment of advanced non-small cell lung cancer requires histologic proof of diagnosis, careful staging, and assessment of each patient’s performance status and comorbidities. For patients with stage IIIB (pleural effusion) and stage IV disease who have a Cancer and Leukemia Group B performance status (PS) of 0 to 1, appropriate management consists of combination chemotherapy with a platinum (either cisplatin or carboplatin) combined with paclitaxel, gemcitabine, vinorelbine, docetaxel, or CPT-11. Dosages and schedules previously established by large phase II or phase III studies should be followed. Variations in the toxicity patterns, schedules of administra-tion, and economic considerations should guide the selection of the specific regimen. For patients who maintain a good performance status after first-line chemotherapy, second-line treatment may be considered. Current evidence supports the use of docetaxel as second-line treatment if the patient has not previously received this drug. Gemcitabine and paclitaxel may also have activity in this setting. Vinorelbine, ifosfamide, and CPT-11 appear to be inactive as second-line therapy for patients who have previously received platinum-based chemotherapy. For patients with a PS of 2, single-agent chemotherapy with vinorelbine, gemcitabine, or a combination of the two should be considered. Patients with poor performance status should be treated with supportive measures designed to relieve pain and acute complications because any tumor-directed therapy has limited benefit. Special situations exist in which curative therapy for metastatic disease is a possibility. Patients who present with solitary sites of metastatic disease, particularly after a long disease-free interval and in the CNS may undergo definitive surgery or radiotherapy with curative intent. Some have also reported favorable outcomes for patients with solitary adrenal or bone metastases as well. Surgical treatment or definitive radiotherapy should not be employed unless a thorough restaging evaluation is performed that includes computed tomography scan of the chest and abdomen through adrenals, brain magnetic resonance imaging, and positron emission tomography scan. A plethora of new agents targeting angiogenesis, tumor invasiveness, the hypoxic environment of tumors, and the cell cycle are currently in development.

Band Erosion with Gastric Cancer

Adjustable gastric banding is a well-established procedure for the treatment of morbid obesity. We present a 62-year-old female who experienced the rare complication of intragastric band perforation due to a gastric adenocarcinoma localized at the site of gastric banding, 10 years after insertion of the band.

Advanced larynx cancer

Opinion statement  Despite advances in diagnosis and treatment, the prognosis for patients with stage III–IV laryngeal cancer is not significantly different than it was four decades ago [1]. This failure to improve survival is multifactorial and is likely linked to controversy surrounding optimal treatment regimens for a heterogeneous patient and tumor population. At the root of this controversy is a lack of randomized controlled trials that compare different therapeutic options, personal and institutional treatment philosophies, and a paucity of standardized functional and quality-of-life outcome measures for specific treatment modalities. Therapeutic decision making is further complicated by the potential use of organ preservation approaches in some patients [2··,3·,4··]. Clearly, quality-of-life considerations are an integral part of treatment planning and a well-informed patient is necessary to achieve an optimal result. Philosophically, it is the physician’s responsibility to recommend the best treatment option and to explain the other viable treatment strategies. It is our opinion that conservation laryngeal surgery represents the mainstay of treatment for patients with advanced laryngeal carcinomas, whose tumors have characteristics amenable to these approaches and who functionally can tolerate such procedures. For those patients who would likely require a total laryngectomy or who are not suitable for surgical conservation, organ preservation should be used as a primary option in a controlled setting.

Gastric Cancer Occurring After Vertical Banded Gastroplasty

A case of gastric cancer after vertical banded gastroplasty (VBG) is presented. A 44-year-old man presented with vomiting and weight loss 6 years after VBG. Endoscopy revealed a poorly differentiated gastric adenocarcinoma. The patient underwent a Whipple pancreaticoduodenectomy and received chemotherapy. He expired 6 months later. From our case and review of the literature, development of gastric cancer after VBG is very rare. The authors suggest that patients undergoing VBG be monitored by endoscopy after the operation.

Advanced gallbladder cancer: Indian “middle path”

Abstract  Gallbladder cancer (GBC) is common in northern India. The western world has a pessimisctic attitude towards GBC resulting in inadequate management of even early GBC. At the other extreme is the Japanese aggressivism with high mortality but very few actual long-term survivors. The Indian surgeons have adopted a Buddhist “middle path” — aggressive surgical approach for “less advanced” GBC and non-surgical palliative approach for “more advanced” GBC. We rely heavily on staging laparoscopy to detect metastatic deposits on liver, peritoneum and omentum, and upper gastrointestinal endoscopy (UGIE) to detect duodenal infiltration which indicates unresectability as we do not perform pancreatico-duodenectomy for GBC. Our favoured procedure is extended cholecystectomy (EC) which includes a 2 cm nonanatomical wedge of liver in the GB bed and the lymph nodes in hepatoduodenal ligament, behind the duodenum and head of pancreas and along the hepatic artery to the right of celiac axis. EC can achieve R0 resection in patients with T1-T2 and T3 (fundus/body — hepatic bed type) disease. For T3 (neck — hepatic hilum type) and T4 disease major hepatic resection is required. In selected patients with nodally advanced GBC, a non-curative simple cholecystectomy with post-operative chemoradiotherapy may improve survival. GBC is an “Indian disease” and Indian surgeons have to be prepared to accept the “challenge” of GBC.

C?lioscopie en chirurgie du cancer colorectal

La Haute Autorité de Santé diffuse un document réalisé par l’Agence nationale d’accréditation et d’évaluation en santé au titre de son programme de travail de 2004.

Curiethérapie du cancer du col de l’utérus

Entretien réalisé le 12 mai 2005, dans le cadre d’un échange de points de vue entre deux curiethérapeutes, Philippe Quétin et Christine Haie-Meder, et deux psycho-oncologues, Marie-Frédérique Bacqué et Eliane Marx, au sujet de la curiethérapie du cancer du col de l’utérus. Bien qu’il s’agisse de la même thérapeutique, les avis restent partagés sur les attentes des femmes sur leur sexualité, leur facilité à interroger leur médecin et leur fa?on de vivre la curiethérapie.

Advanced cervical cancer

Opinion statement  Several large, prospectively randomized clinical trials run by multi-institutional cooperative groups have established that the best treatment for advanced cancer of the cervix is primary radiotherapy with concurrent, cisplatin-based chemotherapy. In fact, patients with earlier stage cervix cancer with poor prognostic indicators (large, bulky tumors, positive pelvic lymph nodes, or unexpected parametrial disease at the time of surgery) also show a survival benefit with this approach. Adequate radiation dosing (both external beam and intracavitary) is essential. The additional benefit of periaortic lymph node irradiation is debated, but generally accepted, for patients with locally advanced disease or pelvic lymph node involvement.

Adjuvant treatment strategies for pancreatic cancer

Abstract  Pancreatic cancer is a difficult and unsolved surgical problem. It remains one of the top five causes of cancer-related deaths and has the lowest 5-year survival of any cancer, largely due to late diagnosis, low resection rates, and local recurrence. Clinical trials examining the optimal timing and delivery of adjuvant therapies for pancreatic cancer have yielded controversial results. Although most experts agree that the addition of chemotherapy has survival benefit in patients with resectable pancreatic cancer, there is no consensus regarding the optimal therapeutic agents, timing (neoadjuvant versus adjuvant), and the addition of radiation therapy to the treatment regimen. Multiple phase III trials are in progress in efforts to examine these issues. Additionally, exciting progress has been made with novel chemotherapeutic combinations, and alternative treatment modalities including interferon-α, immunotherapy, and pancreatic cancer stem cells. Given the high failure pattern after surgical resection, with more than half of patients developing locoregional recurrence, all patients undergoing pancreaticoduodenectomy are candidates for adjuvant therapy.

Adjuvant therapy of colon cancer in idiopathic leukopenia

Abstract  Colorectal cancer is a common malignancy. Surgical resection is the primary treatment modality and the outcome is closely related to the extent of the disease at presentation. Adjuvant chemotherapy with 5-fluorouracil and leucovorin is the standard therapy for resected node-positive disease. This therapy can cause myelosuppression. We present a case of colon cancer with idiopathic leukopenia who tolerated chemotherapy without worsening of leukopenia.

Adjuvant therapy of colon cancer in idiopathic leukopenia

Abstract  Colorectal cancer is a common malignancy. Surgical resection is the primary treatment modality and the outcome is closely related to the extent of the disease at presentation. Adjuvant chemotherapy with 5-fluorouracil and leucovorin is the standard therapy for resected node-positive disease. This therapy can cause myelosuppression. We present a case of colon cancer with idiopathic leukopenia who tolerated chemotherapy without worsening of leukopenia.

Adjuvant therapy for colon cancer

Abstract  As there have been advances in the treatment of metastatic colorectal cancer, exciting developments have also been achieved in the adjuvant treatment of colon cancer. At the same time, more questions have been raised, and some controversies remain. The results of the MOSAIC trial demonstrated the benefit of adding oxaliplatin to 5-fluorouracil (5-FU) and leucovorin (FOLFOX) in adjuvant therapy for stage II and III disease, but the optimal duration of therapy and the management of toxicities remain to be resolved. Capecitabine is at least equivalent to the Mayo Clinic bolus 5-FU and leucovorin regimen in the adjuvant treatment of stage III colon cancer with a lower incidence profile of adverse events, allowing additional options for patients and physicians. Routine adjuvant systemic therapy in all patients with stage II colon cancer is still debatable. Although a statistically significant advantage for adjuvant treatment in stage II disease was shown for the first time from a large randomized study (QUASAR), the subsets of patients who truly benefit from therapy need to be identified. The application of pharmacogenetics and pharmacogenomics in adjuvant therapy for colorectal cancer will help to distinguish those patients with risk factors and to guide individualized therapy.

Imaginaire social et Cancer

Résumé:  Nous tenterons ici de décrypter l’imaginaire social contemporain du cancer en se fondant sur l’analyse des principales représentations sociales (profanes et savantes) de cette pathologie, qui ont cours actuellement en France. Mais plus qu’une pathologie, le cancer génère un authentique ?univers culturel? qui vient révéler et questionner les mentalités et les conduites collectives, compte tenu à la fois de son importance épidémiologique, de sa forte charge symbolique et de la mobilisation croissante des associations de malades. C’est autour de ces trois aspects que nous développerons notre propos.

Purpose  The purpose of this national study was to evaluate the results of treatment for young rectal cancer patients.

Abstract   Our aim was to study the three-fold response to treatment, survival rates and toxicity.

Materials and methods   We review 76 patients (median age 66.2 years) affected with the disease. All received adjuvant chemotherapy, while 13 with rectal cancer were subjected to radiation too. Patients were staged after Dukes classification.

Purpose  Many considerations, such as morbidity, sexual and urinary dysfunction, or risk of definitive stoma have led to the increased popularity of local therapy in the therapeutic strategy for rectal cancer. However, its role in curative intent is still controversial with oncologic long-term results lower than those obtained by radical surgery.

Adjuvant chemotherapy in breast cancer

Summary  Breast cancer is the most common malignancy in women in Western Europe and the U.S. Adjuvant chemotherapy reduces the rate of cancer recurrence, thereby contributing to the recent decline of breast cancer mortality. Notably, a number of important developments occurred over the past decades. Starting with first generation regimens like CMF, the next step was the introduction of anthracyclines into the adjuvant setting, although the role of these drugs is again dubious today. Modern regimens followed with the introduction of taxanes into the adjuvant setting, and a number of further developments are under way: Dose dense regimens as well as targeted therapies have led to a new era of treatment of women with early breast cancer. Neoadjuvant chemotherapy, while sometimes still debated, has increased the rate of breast conserving surgeries. Obviously, both neoadjuvant, therefore preoperative, and adjuvant chemotherapy have their specific advantages and drawbacks. This will be dealt with in detail. Also a short overview of available data on adjuvant chemotherapy in the elderly is provided. The history, recent developments, as well as open questions will be discussed in this review.

Adjuvant chemotherapy for primary breast cancer

Abstract  For patients with hormone-unresponsive or higher-risk operable early-stage breast cancer, adjuvant chemotherapy significantly reduces the risks of relapse and death. The prognosis for such patients, especially those presenting with extensive axillary lymph node involvement, remains poor. New chemotherapy agents and novel administration schedules have recently been shown to improve clinical outcome. This overview provides a summary of the state of the art and the most recent developments regarding adjuvant chemotherapy for primary breast carcinoma.

Adjuvant chemotherapy for colon cancer

Abstract  Colon cancer remains the third most common cancer, and cause of cancer-related death in the United States. Greater public awareness and acceptance of screening programs have contributed significantly to increasingly earlier detection of colon cancer and decreased mortality. Advances made in the understanding of this disease, both in terms of its clinical behavior and molecular pathogenesis, have translated into major improvements in its therapy. Several large randomized trials during the last two decades have helped the oncology community forge a successful multi-modality treatment strategy against colon cancer. These studies have defined the role of adjuvant therapy for colon cancer after curative surgery. Despite all the advances, a large number of patients continue to succumb to this disease, and the search for better therapies is still necessary. In this article, we discuss the evolution and the current state of adjuvant chemotherapy in colon cancer and briefly review new developments.

Tumour cells resistance in cancer therapy

Resistance to chemotherapeutic drugs presents a big caveat for cancer treatment. In this review we will describe the molecular mechanisms involved in chemoresistance, discussing the mechanisms of resistance related to tumour microenvironment, as well as their intracellular mechanisms. Chemoresistance can also appear as a consequence to treatments with new anticancer drugs. In this sense, we will exemplify this type of resistance discussing mechanisms of action of epidermal growth factor receptor (EGFR) inhibitors. We conclude that the main problem of chemoresistance is due to its pleiotropic and multifactorial nature.

Adipositas und Krebs

Zusammenfassung  Die Prävalenz der Adipositas nimmt in alarmierendem Ausmaß zu. Gesundheitliche wie ökonomische Konsequenzen sind bedeutsam, da Adipositas mit zahlreichen Erkrankungen assoziiert ist. Umfangreiche prospektive Studien zeigen, dass Adipositas auch mit mehreren Krebsarten signifikant assoziiert ist. Die IARC der WHO hält die Beweise hinsichtlich des kausalen Zusammenhanges von Übergewicht und Karzinomen des Kolons, der Mamma (postmenopausal), des Endometriums, der Niere (Nierenzellkarzinom) und des Ösophagus (Adenokarzinom) für ausreichend. Zu den potenziellen pathogenetischen Mechanismen gehören u. a. gesteigerte Insulinresistenz, chronische Hyperinsulinämie und die erhöhte Bioverfügbarkeit von Steroidhormonen. Zudem konnte gezeigt werden, dass Adipozytokine in gewissem Maß am Prozess der Karzinogenese beteiligt sind. Am überzeugendsten hat die Womens Intervention Nutrition Study zeigen können, dass Lebensstiländerungen das Risiko für ein erneutes Auftreten von Brustkrebs sogar vermindern können.

Molecular biology of bladder cancer

Bladder cancer is a major cause of health expenses and it presents formidable clinical challenges. Two types of tumors have been identified, papillary and non-papillary. The former are mainly characterized by FGFR3 and chromosome 9 alterations and a low frequency of Tp53 alterations. The latter are characterized by a high frequency of alterations in genes in the p53 and Rb pathways. Chromosome 9 alterations, specially in 9q, are crucial to bladder cancer development and occur in both types of tumors. Progression of some superficial tumors (mainly TaG3 and T1G3) to high-grade, invasive, carcinomas provides evidence of some overlap between the two pathways. Distinct gene expression profiles have been identified in superficial and invasive tumors. The stage is now ready for the clinical application of this knowledge.

Adenosine triphosphate for cancer cachexia

Le cancer du sein est-il un cancer nutritionnel?

Resumé:   Le cancer du sein est la première cause de mortalité féminine avant 65 ans. Si la mortalité décro?t, son incidence augmente régulièrement, c’est dire que sa prévention est un objectif majeur de santé publique. L’altération du métabolisme des hormones sexuelles appara?t comme le facteur de risque essentiel du cancer du sein. Ce métabolisme peut être influencé par l’alimentation, en premier lieu par un déséquilibre énergétique entra?nant surpoids ou obésité, notamment à la ménopause. L’excès de tissu adipeux sera le lieu de synthèse d’estrogènes, facteurs de croissance des cellules tumorales. Pendant l’adolescence, un apport alimentaire trop riche, notamment en protéines, entra?nera une forte et rapide croissance, résultant de la stimulation de l’hormone de croissance, qui elle-même permet la synthèse de l’IGF-1, autre facteur de croissance des cellules tumorales. Les lipides contribuent à un apport énergétique déséquilibré, par leur densité énergétique, mais les acides gras polyinsaturés agiraient de fa?on spécifique: on a montré le r?le favorable des acides gras ω 3 à longue cha?ne. Les fibres, qui diminuent la densité énergétique, tendent à réduire le risque. Parmi les phyto-estrogènes, les isoflavones du soja ont été les plus étudiées, étant donné la réduction du risque de cancer du sein observée dans les pays asiatiques où le soja est régulièrement consommé. Mais il est encore difficile d’identifier la cause spécifique de cette observation, effet hormonal des isoflavones, soja dans son entier ou profil alimentaire bénéfique. Il semble donc possible d’agir sur le risque de cancer du sein par l’alimentation, mais celle-ci étant considérée de fa?on globale.

ADAMs, cell migration and cancer

Chirurgie du cancer du sein après traitement néo–adjuvant

Résumé:   Les traitements néoadjuvantsdu cancer du sein sontemployés de plus en plus souvent.Ils confèrent des aspects particuliersà la technique chirurgicale. Le problèmeprincipal est posé par laréponse clinique complète aprèschimiothérapie. Ici plus quailleurs,la multidisciplinarité permet de surmonterces difficultés.

ADAMs, cell migration and cancer

Chirurgie du cancer du sein après traitement néo–adjuvant

Résumé:   Les traitements néoadjuvantsdu cancer du sein sontemployés de plus en plus souvent.Ils confèrent des aspects particuliersà la technique chirurgicale. Le problèmeprincipal est posé par laréponse clinique complète aprèschimiothérapie. Ici plus quailleurs,la multidisciplinarité permet de surmonterces difficultés.

Chirurgie du cancer du sein après traitement néo–adjuvant

Résumé:   Les traitements néoadjuvantsdu cancer du sein sontemployés de plus en plus souvent.Ils confèrent des aspects particuliersà la technique chirurgicale. Le problèmeprincipal est posé par laréponse clinique complète aprèschimiothérapie. Ici plus quailleurs,la multidisciplinarité permet de surmonterces difficultés.

Cancer et temporalité: un aussi long parcours...

Résumé:   Les progrès et lévolution des traitements ont considérablement allongé lespérance de vie des patients en cancérologie. Il nest pas rare de rencontrer des malades porteurs de cancer métastatique qui sont aux prises avec la maladie depuis plusieurs années (cancer du sein, de la prostate par exemple). Or, le fait même de nommer «patients» les sujets malades dont nous nous occupons fait demblée appel à la notion de temps. Le malade, cet être si patient... Dans le déroulement de la maladie grave, du cancer en particulier, cest donc bien la question du temps, mais bien plus encore celle de la temporalité qui est au cur de la problématique. Tenter de se pencher sur cette question nous amène dès lors à nous interroger sur ses aspects phénoménologiques. Quelle est lexpérience du temps et de la temporalité chez la personne malade? Que font vivre ces étapes: de lannonce du diagnostic, des traitements, en passant par la rémission, voire la guérison, la récidive ou bien encore la fin de vie? Comment psychiquement peut-on sorganiser dans ces méandres incertains et redoutables? En quoi lirruption de la maladie vient ébranler le sentiment identitaire des patients? En quoi la parole vient-elle restaurer cette fracture et aider le malade à se sentir «différemment le même»?

Les bisphosphonates dans le cancer de la prostate

Résumé:   Les bisphosphonates (BP) inhibent la résorption osseuse associée aux métastases osseuses ostéoblastiques et interfèrent avec leur formation et leur croissance. Plusieurs études randomisées et non randomisées indiquent que les BP peuvent ëtre utilisés pour soulager la douleur osseuse due aux métastases du cancer de la prostate et diminuer lincidence des complications osseuses tels la fracture pathologique, la compression médullaire ou le recours à la chirurgie ou à la radiothérapie. Sur la base de ces données, lacide zoledronique pourraît être considéré comme le plus puissant des BP dans le traitement des métastases osseuses ostéoblastiques du cancer de la prostate. Une perte osseuse est observée chez les patients après hormonothérapie. Cette perte oseuse peut être prévenue par les BP.

Activated Proteinkinase B in Breast Cancer

Abstract  The content of activated (phosphorylated) form of proteinkinase B in tumors and homologous tissues of 46 patients with breast cancer was measured by enzyme immunoassay. Activity of proteinkinase B was increased in tumors of 48% patients in comparison with homologous histologically unchanged tissue. Activity of proteinkinase B in hormone-dependent mammary tumors was significantly higher than in tumor tissue from patients with negative receptor status.

Cancer et temporalité: un aussi long parcours...

Résumé:   Les progrès et lévolution des traitements ont considérablement allongé lespérance de vie des patients en cancérologie. Il nest pas rare de rencontrer des malades porteurs de cancer métastatique qui sont aux prises avec la maladie depuis plusieurs années (cancer du sein, de la prostate par exemple). Or, le fait même de nommer «patients» les sujets malades dont nous nous occupons fait demblée appel à la notion de temps. Le malade, cet être si patient... Dans le déroulement de la maladie grave, du cancer en particulier, cest donc bien la question du temps, mais bien plus encore celle de la temporalité qui est au cur de la problématique. Tenter de se pencher sur cette question nous amène dès lors à nous interroger sur ses aspects phénoménologiques. Quelle est lexpérience du temps et de la temporalité chez la personne malade? Que font vivre ces étapes: de lannonce du diagnostic, des traitements, en passant par la rémission, voire la guérison, la récidive ou bien encore la fin de vie? Comment psychiquement peut-on sorganiser dans ces méandres incertains et redoutables? En quoi lirruption de la maladie vient ébranler le sentiment identitaire des patients? En quoi la parole vient-elle restaurer cette fracture et aider le malade à se sentir «différemment le même»?

Les bisphosphonates dans le cancer de la prostate

Résumé:   Les bisphosphonates (BP) inhibent la résorption osseuse associée aux métastases osseuses ostéoblastiques et interfèrent avec leur formation et leur croissance. Plusieurs études randomisées et non randomisées indiquent que les BP peuvent ëtre utilisés pour soulager la douleur osseuse due aux métastases du cancer de la prostate et diminuer lincidence des complications osseuses tels la fracture pathologique, la compression médullaire ou le recours à la chirurgie ou à la radiothérapie. Sur la base de ces données, lacide zoledronique pourraît être considéré comme le plus puissant des BP dans le traitement des métastases osseuses ostéoblastiques du cancer de la prostate. Une perte osseuse est observée chez les patients après hormonothérapie. Cette perte oseuse peut être prévenue par les BP.

Activated Proteinkinase B in Breast Cancer

Abstract  The content of activated (phosphorylated) form of proteinkinase B in tumors and homologous tissues of 46 patients with breast cancer was measured by enzyme immunoassay. Activity of proteinkinase B was increased in tumors of 48% patients in comparison with homologous histologically unchanged tissue. Activity of proteinkinase B in hormone-dependent mammary tumors was significantly higher than in tumor tissue from patients with negative receptor status.

Art et cancer. Des mondes étrangers l’un à l’autre ?

Résumé:   Lart et le cancer du sein ont des points de rencontre multiples. Cette maladie figure ici ou là dans la création des artistes contemporains ou anciens. Elle y est exprimée soit dans sa réalité clinique soit dans ses effets psychologiques. Quant aux femmes blessées au sein par le cancer, quelles soient artistes déclarées ou non, elles peignent, sculptent ou dessinent leur maladie. Leurs uvres sont empreintes de leurs souffrances, blessures, peurs ou espoirs.

Acromegaly: Re-thinking the cancer risk

Abstract  Acromegaly is characterized by sustained elevation of circulating growth hormone (GH) and insulin-like growth factor I (IGF-I), and is clearly associated with increased morbidity and overall mortality mainly due to cardiovascular, metabolic, and respiratory diseases. Although cancer-related mortality varies widely amongst retroperspective studies, it appears to be consistently elevated mainly in patients with uncontrolled disease. We review individual tumor types including neoplasms of the colon, breast, prostate, and thyroid where in vitro, animal studies, and studies in non-acromegalic cancer patients have established a role for the GH/IGF-I axis in tumor progression and possibly initiation. We highlight deficiencies in data in acromegalic patients where the evidence is less convincing. Instead, we explore the hypothesis that acromegaly, independent of hormone secretion, is a disease that heralds genetic and/or epigenetic alterations predisposing to cancer risk elsewhere.

Thérapie créative pour les personnes atteintes de cancer: évaluation de l’atelier ? Cancer & Créativité ?

Résumé:   Latelier dart-thérapie « Cancer et Créativité » offre un espace au sein duquel les patients cancéreux Hollandais ont la possibilité dassumer leur maladie par la créativité et lexpression. Cet atelier a fait lobjet dune étude évaluative parmi 5 groupes englobant au total 39 participants. Les groupes se composent presque exclusivement de femmes. Cet atelier répond bien aux besoins des participants qui visent la découverte, lexpression, la capacité à assumer leur cancer et la maîtrise de leurs sentiments, parallèlement à lépanouissement personnel et le contact avec dautres personnes atteintes de cancer. De nombreux participants ont le sentiment que lentretien préliminaire avec le psychiatre na pas sa place dans cette expérience. Les participants sont (très) satisfaits de lorganisation de latelier, mais la plupart dentre eux jugent les réunions trop courtes et souhaitent que les discussions consécutives à ces réunions durent plus longtemps. Les participants affirment quils ont changé dans un sens positif, notamment au niveau du contrôle de leurs émotions, de la mise en route dun processus de prise de conscience et du développement créatif. Latelier a déclenché un processus quils souhaiteraient poursuivre. La comparaison entre lévaluation du bien-être des patients avant et après latelier permet de constater une baisse de la capacité à effectuer les activités de la vie quotidienne (ADL). En revanche, les ateliers leur ont permis de donner davantage de sens à leur vie. En se basant sur le jugement rétrospectif des patients à propos de leur bien-être avant latelier, on constate une amélioration de la qualité de vie générale grâce à elle. Une étude ultérieure devrait permettre davoir une meilleure idée de lévolution des changements lors du suivi dune thérapie créative et de linfluence de celle-ci sur la qualité de vie des personnes atteintes de cancer.