Journal of Integrative Oncology

Aberrant mammary tumors are ectopic tumors, which represent 0.3% of all breast cancers. These tumors often occur close to normal breast, near the sternum, epigastrum, subclavicular, and axillary area which is the most common. We report a 76-year-old woman, without history of disease, presenting one year ago, a nodule located between breasts, increasing rapidly in size. Clinical examination found an inflammatory mid-chest mass, measuring 15cm of diameter, located between breasts. Axillary lymph nodes were not enlarged, and no masses were palpable in the breasts. Biopsy with immuno-histochemical study showed invasive ductal breast origin carcinoma, with positive CK7 antigen, negative CK20 antigen, positive hormone receptors and negative HER2/neu oncoprotein. Bilateral mammography showed invasion the left breast. Computed tomography showed bilateral pulmonary metastasis. The patient received 5 courses of palliative chemotherapy based on Anthracycline, with more than 80% of partial response obtained. The patient died from sepsis before receiving the sixth course of treatment. Aberrant mammary tumors originated from accessory fragments of breast tissue beyond mammary gland. These aberrant breast tissues can grow and cancerize, with or without involvement of the two normal mammary glands. In this case report, both normal breasts are free from any adjacent tumor proliferation, and it is the first case in literature, reporting a considerable size of aberrant breast tissue.

Bladder carcinoma is one of the commonest cancers in Australia and accounts for 2% of all cancers in Australia. According to the European Association of Urology (EAU) Guidelines, macroscopic Transurethral Resection (TUR) is the standard therapy for Ta and T1 papillary bladder tumours. The majority of bladder tumours are Non-Muscle Invasive (NMIBC) and are usually curable by endo-resection. However, despite the use of currently available equipment, the recurrence rate for bladder tumours remained very high.
Our aim is to highlight the new technologies available for the diagnosis and management of NMIBC. A review of the literature was performed using a PubMed search.
We conclude that new modalities in detection (Photodynamic Diagnosis (PDD) and Narrow Band Imaging (NBI)) and management (bipolar transurethral resection and en bloc resection) of bladder tumours might play a vital role in reducing the recurrence rate of bladder tumours.

Background: The use of capecitabine has risen exponentially in the Netherlands since 2001. Clinical trials describe a mild toxicity profile. Because circumstances in daily clinical practice can differ a lot from clinical trial setting, we performed this retrospective analysis in a large community hospital to verify toxicity in a clinical situation.
Methods: A retrospective cohort study was conducted in patients with malignancies of the gastrointestinal tract or breast treated with capecitabine in the period of January 2007 to January 2009. Primary study endpoint was the incidence and severity of capecitabine-induced toxicity in daily clinical practice. Secondary endpoint concerned determination of risk factors for toxicity due to capecitabine.
Results: Of 281 patients 92% experienced some degree of toxicity. Grade 3-4 toxicity occurred in 30% of patients receiving monotherapy and in 47% with combination therapy. This was in accordance with the literature. Type of toxicity varied, but gastro intestinal symptoms and hand foot syndrome were most commonly found. Risk of toxicity increased with increasing age, independently of creatinine clearance.
Conclusions: Therapy with capecitabine monotherapy or capecitabine containing regiments in daily clinical practice is accompanied by considerable toxicity, but frequency and severity are consistent with published clinical trials. More toxicity can be expected with increasing age.

Background: Surgery, especially visceral surgery plays a crucial role in palliative care and is part of the interdisciplinary treatment in advanced malignancies with reduced live expectancy.
Methods: An overview to document the up to date knowledge in the field of palliative surgery by reviewing and researching selective databases (Pubmed, Cochrane Library) and selected journals.
Results: Visceral surgery is a significant part of palliative care. Surgery is indicated in the emergency situation, in individual cases and when alternatives have been exhausted. Aim of the surgery is long-term and rapid control of symptoms, increasing the quality of life and decreasing the hospital stay.
Conclusion: The option of visceral surgery in advanced malignancies should be considered in each case individually due to the different tumor characteristics and localization. After critical reviewing, surgery can be indicated and must be integrated into a network of palliative care with available add-on therapies.

Despite the large economic and intellectual efforts, cancer is still not easily treatable disease by conventional therapies. This led ultimately to reconsider hyperthermia, like one of interesting treatment methods connected to immunity and tumor metabolism. Hyperthermia has also the ability to play an additional role when used together with the conventional methods of treatment: surgery, radiotherapy, chemotherapy and immunotherapy. Recent trials in Holland and Germany have demonstrated that hyperthermia can prolong life and decrease disease re-appraisal when used in combination with radiotherapy and chemotherapy. Some tumors seem more responsive than others. In this brief summary we will attempt to give a vision of hyperthermia from a physical stand point, but more importantly we will give clinical and biological aspects. The results obtained in these trials on certain types of cancers such as cervix cancer, recurrent breast cancer and head neck cancer, melanoma, sarcomas, liver, glioblastoma and pancreatic cancer support the use of this technique, although some clinical and technical problems persist and have not been completely resolved.

Objective: Nausea and emesis are two major side effects and known to be partly psychological rather than purely pharmacological in nature. Yoga as a complimentary modality is extensively known to reduce anxiety, physiological arousal and stress associated with chemotherapy. This study will compare the effect of Yoga with Jacobson's relaxation to understand the underlying neural mechanisms like gastric motility changes (Electrogastrogram) and sympathovagal changes on HRV spectral analysis that accompany chemotherapy induced nausea and emesis and evaluate the influence of intervention on these mechanisms.
Method/Design: This is a randomized controlled 3 arm clinical Trial. 120 chemo naive subjects will be randomized into three groups, with 42 subjects for Yoga, 42 for Jacobson's group and 36 in control group.
Setting: This study will be conducted at Comprehensive cancer care hospital.
Participants: 200 patients will be screened and 150 subjects who satisfy the selection criteria (those with gynecological malignancies, between 18-70 years, with basic education and those who have never been exposed to chemotherapy before and who give their consent to participate and give consent to participate) will be taken into the study.
Primary outcome measure: The Functional Living Index-Emesis (FLIE), emesis-and nausea-specific Qol questionnaire is administered with a 24 hour recall followed by a 4-day recall for studying acute and delayed chemotherapy-induced emesis.
Secondary outcome measure: Include psychological measures such anxiety, depression and perceived stress that influence chemotherapy induced nausea and emesis. It also includes cardiac autonomic function and surface electrogastrogram to assess the neurophysiological correlates of yoga in modulating nausea and emesis.
Intervention: The yoga intervention consists of asanas (postures), breathing exercises, and relaxation techniques for 25 minutes. The progressive muscle relaxation involves tightening each and every muscle of the body and then relaxing the same one by one for 25 minutes.
Conclusion: This study will help us understand the mechanism of action of yoga intervention in controlling chemotherapy induced nausea and vomiting.

Objective: Peritoneal Metastases (PM) of Gastric Cancer (GC) are lesions of peritoneal surfaces, which may cause the dissemination throughout the abdominal cavity. The role of laparoscopic Hyperthermic Intraperitoneal Chemotherapy (HIPEC) as neoadjuvant purpose in the management of PM of GC is undefined.
Methods: Fifty patients were enrolled into this study with histopathological diagnosis of PM of GC referred to our center between 2012 and 2013 All patients were underwent two cycles of neoadjuvant laparoscopic HIPEC. At the second session of LHIPEC, ascites volume, cytological status and PCI levels were compared with those at the 1st LHIPEC.
Results: There was no intraoperative complication and mortality after LHIPEC. Four patients developed mild azotemia of Grade 2. Amount of ascites were completely abolished or decreased in 22 of 34 (64.7%) and positive peritoneal cytology changed to be a negative in 14 of 20 (70%) patients at the 2nd LHIPEC. Complete response was in 6 (12%), and peritoneal cancer indices (PCI) were significantly reduced from 14.3 ± 10.2 at the 1st LHIPEC to 10.8 ± 10.5 at the 2nd LHIPEC (p<0.05). Furthermore, total PCI scores on small bowel mesentery at 1st and 2nd LHIPEC were 6.56 ± 2.92 and 5.25 ± 3.78 (P=0.016).
Conclusions: This study identified two outcomes. Diagnostic and therapeutic laparoscopy can be performed safely in patients with PM of GC. Laparoscopic HIPEC can be applied as a neoadjuvant treatment modality in order to reduce the tumor burden and disease control until complete managements to be achieved in patients with PM of GC.

Background: Glioblastoma Multiforme (GBM) belongs to the most aggressive brain tumours with limited therapeutic options. In the clinical presentation often dominate the mental changes (memory loss, impaired speech, changes in personality and temperament). The authors evaluate in a pilot study the neurocognitive function of patients with GBM.
Patients and Methods: The evaluation of neurocognitive function had been performed during 2009-2010 in eleven patients with GBM (9 women, 2 men) with a mean age of 56.8 years (age range 45-72). The assessment of neurocognitive functions was performed by clinical neuropsychologist using the methods sensitive for cognitive deficit.
Results: Because of a limited set of patients and an insufficient number of schedule check-ups (caused by severe tumour progression) the results could not be statistically evaluated. Due to these circumstances, the results of a pilot project are presented in the form of a case series. There are presented the results of three patients with different localization of GBM and with different type of neurosurgical intervention (total resection, subtotal resection and stereotactic biopsy).
Conclusion: The diagnosis of cognitive deficit can be based on careful assessment of personal medici history, present symptoms and physical examination. Laboratory tests and paging technique help by the detection of secondary cognitive changes. Targeted examination of cognitive function relies in use of various neuropsychological tests. To monitor developments and changes in cognitive functions in patients with GBM the following battery of neuropsychological tests has shown helpful information: Addenbrooke´s Cognitive Examination, Trail Making Test, Rey-Osterrieth Complex Figure and Verbal Fluency Test. It seems that this battery of neuropsychological tests is suitable for repeated long-term monitoring of cognitive function in cancer patients undergoing radiotherapy of brain.

Background: The lung is the second most common site for metastatic malignant melanoma, with a poor prognosis. In this regard, identify clinicopathological predictors for Melanoma Lung Metastases (MLM) plays a pivotal role in clinical practice.
Methods: We computer-searched the clinical records of all our patients registered in our melanoma database to identify patients that presented MLM. Kaplan-Meier product was used to estimate time to MELANOMA LUNG METASTASES (TMLM) and Overall Survival (OS); while the log-rank test was used to evaluate differences between the survival curves. Cox proportional hazards regression was performed in the analysis between clinicopathological features of the primary tumor and MLM.
Results: A total of 63 patients with MLM were included in our analysis. Median TMLM was 27.4 months, while median OS was 55.5 months, with a Median Lung Metastases Survival (MLMS) of 10 months. Melanoma patients with a primary axial tumor (p<0.001) and with an age ≤ 60 years (p=0.01) showed a better TMLM. While OS was statistically significant higher only in axial melanomas (p<0.001), multivariate analysis showed that peripheral site of the primary tumor remained the main predictor to develop MLM, with a significant influence in TMLM and also in the long-term (p<0.01 and p=0.04).
Conclusions: Currently no standardized therapies exist for MLM. In this regard, the prevention of secondary recurrences plays a pivotal role in the management of melanoma patients. According to our results, peripheral melanoma is the main predictor for development of MLM.