scholarly journals Impact of a delayed diagnosis of vulvar cancer and its association with HIV infection: A 4-year review at a tertiary hospital in KwaZulu-Natal, South Africa

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Ramakhosana S. Hlapane ◽  
Thandekile L. Khumalo ◽  
Bongumusa S. Makhathini ◽  
Jagidesa Moodley
Keyword(s):  
Hiv Infection ◽  
Vulvar Cancer ◽  
Early Stage ◽  
Tertiary Hospital ◽  
Time Interval ◽  
Early Stage Disease ◽  
Cd4 Counts ◽  
Stage Disease ◽  
Diagnosis Of Cancer ◽  
The Impact

Background: Vulvar cancer is becoming more common in young women owing to the increased prevalence of co-infection with human papillomavirus and HIV.Objectives: The aim of this study was to determine the impact of the time interval from the diagnosis of vulvar cancer at the referring institution to the tertiary hospital and to evaluate the impact of HIV infection in the study population.Method: This was a retrospective descriptive chart review.Results: A total of 86 cases of vulvar cancer were analysed. The mean age was 48.2 ± 12.5. Sixty (69.8%) patients were under 50 years of age and eight (9.3%) under 30 years. The interval from the onset of symptoms to the diagnosis of cancer was 12 months in 63 (73.3%) patients. Eighty-one (94.8%) had had symptoms treated multiple times prior to diagnosis. Seventy (81.4%) were referred to the tertiary institution within 3 months of the diagnosis of cancer. Seventy (81.4%) had concomitant HIV infection. Of those with CD4 counts of 200 cells/mm3, 61.7% had early-stage vulvar cancer, while 38.3% had late-stage disease (P = 0.048). There was no association between the viral load and the Federation of Gynaecology and Obstetrics stage (P = 0.401). The primary treatment was surgery in 50%.Conclusion: Although the study was retrospective, we found that vulvar cancer was prevalent in younger patients with HIV infection. Higher CD4 counts were associated with early-stage disease. Early sampling of suspicious lesions can ensure early diagnosis of vulvar cancer and the initiation of therapeutic interventions, particularly in HIV-infected patients.

scholarly journals Clinical and histopathological pattern of colorectal malignancies, the experience in a tertiary hospital in south-western region, Saudi Arabia

2018 ◽  
Vol 5 (11) ◽  
pp. 4684
Author(s):  
Majed Saleh M. Aldayhum ◽  
Anas Abdullah R. Alshehri ◽  
Dlaim H. AlQahtani ◽  
Eman Yahia Alfussaily ◽  
Suha Abdulrahman S. Althibait ◽  
...  
Keyword(s):  
Saudi Arabia ◽  
Clinical Presentation ◽  
Early Stage ◽  
Tertiary Hospital ◽  
Central Hospital ◽  
Early Stage Disease ◽  
Common Cancer ◽  
Stage Disease ◽  
Common Grade ◽  
The Mean

Background: Colorectal cancer is the third most common cancer all over the world and the second leading cause of the cancer death in both sexes. CRC is the second most common cancer in Kingdom Saudi Arabia. However, this aspect was not recently studied.Methods: This is a retrospectively cohort based study. We collected and analyzed the records of the patients with CRC diagnosed at Aseer Central Hospital, Abha, Saudi Arabia from January 2008 to June 2016. A pre-specified data sheet was used to collect information regarding socio-demographics, age, Altitude, site of tumor, clinical presentation, outcome and prognosis as well as histopathological pattern of cancer and the stages of disease. Descriptive statistics was performed using SPSS.Results: A total of 291 cases of CRC were registered in the Aseer Central Hospital. 171 cases 58.87% were males while 120 cases 41.2% were females. The mean age of patients (SD) at the time of diagnosis was 59.38 years. At the time of diagnosis, 219 patients 84.6% presented with early stage disease and 40 15.4% had distant metastasis advanced stage. The most frequent CRC located in sigmoid 26.5%, rectal 23.7%and 14% in ascending. The moderately differentiate adenocarcinoma grade of tumor is being the most common grade among all variants 75.6%.Conclusions: In this study, we have nearly similar results found in previously published study by Alshehri et al. Males considered most affected, most of the patients were more than 50 years, 84.6% of the patients came with early stage disease. Left side colon were the most common site of CRC.

Frequency of late-stage breast cancer diagnoses despite high mammography screening rates in an HMO

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. 1526-1526
Author(s):  
R. Haque ◽  
J. E. Schottinger ◽  
M. H. Kanter ◽  
C. C. Avila ◽  
R. Contreras ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Late Stage ◽  
Mammography Screening ◽  
Early Stage ◽  
Advanced Tumor Stage ◽  
Early Stage Disease ◽  
Advanced Tumor ◽  
Stage Disease ◽  
Late Stage Diagnosis ◽  
The Impact

1526 Background: Kaiser Permanente Southern California (KPSC) led the nation in screening women for breast cancer (BCa) with a mammography rate of nearly 90% in 2007 according to 2008 Healthcare Effectiveness Data and Information Set (HEDIS) measures. Despite successes in improving screening rates in this health plan that serves 3+ million diverse members, the percentage of women diagnosed with late stage BCa (stage III, IV) remained stable, varying from 12.9% (N∼323) in 2003 to 10.8% (N∼270) in 2007. To identify patient and health care factors associated with late stage diagnosis and the impact of its enhanced screening implementation guidelines, KPSC undertook this study. Methods: This cross-sectional study included a cohort of 10,580 BCa patients from 2003–2007. We compared women diagnosed with late stage disease versus those with early stage disease (stages I, II). P values (2-sided) were based on the chi-square distribution. Adjusted odds ratios and 95% confidence intervals were estimated using unconditional logistic regression. Results: Factors that were positively associated with late stage diagnosis in the univariate analyses included age, lack of recent mammography screening, worse tumor features, 80+ years of age, minority race, lower geocoded household income, increased healthcare visits, and use of Pap testing (P < 0.01 for all variables). Factors significantly associated with late stage diagnosis in the multivariate model included only lack of recent mammography screening (OR = 1.35, 95% CI: 1.14–1.58) and worse tumor features including high grade (grade 3, OR = 2.58, 95% CI: 1.96–3.40), positive lymph nodes (OR = 53.49, 95% CI: 39.90–71.72), and HER-2+ tumors (OR = 1.40, 95% CI: 1.13–1.72). Conclusions: Targeting older women, those with lower utilization, and women who did not have a recent mammogram may help further lower the prevalence of late stage diagnoses. However, given the extent of the health plan's previous efforts to enhance BCa screening rates, a ceiling effect may limit additional benefit. Additional efforts to decrease the rate of advanced tumor stage at diagnosis may include improving interpretation of mammograms or earlier detection of aggressive tumors by enhanced BRCA genetic testing. No significant financial relationships to disclose.

Management of Melanoma during Pregnancy: A Case Series of 11 Women Treated at NYU Langone Health

Oncology ◽  
2020 ◽  
Vol 98 (12) ◽  
pp. 847-852
Author(s):  
Amelia E. Sawyers ◽  
Anna C. Pavlick ◽  
Jeffrey S. Weber ◽  
Iman Osman ◽  
Jennifer A. Stein
Keyword(s):  
Early Stage ◽  
Case Series ◽  
Advanced Stage ◽  
Early Stage Disease ◽  
Melanoma Diagnosis ◽  
Stage Disease ◽  
Treatment Plans ◽  
Melanoma Patients ◽  
The Impact

<b><i>Objectives:</i></b> Melanoma is one of the most common malignancies diagnosed during pregnancy. This study examined the impact of pregnancy on management decisions of melanoma patients treated at NYU Langone Health (NYULH). <b><i>Methods:</i></b> We analyzed data for patients who were pregnant at initial or recurrent melanoma diagnosis at NYULH from 2012 to 2019 with prospective protocol-driven follow-up. <b><i>Results:</i></b> Of the 900 female patients accrued during this period, 11 women in the childbearing range were pregnant at melanoma diagnosis. Six patients presented with early (stage 0 or I) disease and five with advanced (stage III or IV) melanoma. Women with early stage disease had normal deliveries and minimal changes to their treatment timeline and regimen. However, patients with more advanced stage disease opted for either termination of the pregnancy or early delivery and altered treatment timelines because of pregnancy. <b><i>Conclusion:</i></b> Both melanoma stage and gestational age at diagnosis contribute to the differences in the therapeutic management of melanoma in pregnant women. Given the complexity and variety of each case of melanoma during pregnancy, informed discussion between patients and physicians allows for individualized treatment plans that address each patient’s unique situation.

scholarly journals Time from Diagnosis to Initiation of Curative Chemotherapy Affects Outcomes in DLBCL - Data from a Large Asian Cohort

Blood ◽  
2016 ◽  
Vol 128 (22) ◽  
pp. 1871-1871
Author(s):  
Colin Phipps ◽  
Yuh Shan Lee ◽  
Chandramouli Nagarajan ◽  
Yunxin Chen ◽  
Allan ZK Goh ◽  
...  
Keyword(s):  
Cox Regression ◽  
Early Stage ◽  
B Cell Lymphoma ◽  
Continuous Variable ◽  
Disease Stage ◽  
Advanced Stage ◽  
Early Stage Disease ◽  
Stage Disease ◽  
Stage 1 ◽  
The Impact

Abstract Diffuse large B-cell lymphoma (DLBCL) is a high-grade lymphoma that requires treatment. It remains unclear how promptly curative anthracycline-based immunochemotherapy should be started and the prognostic effects time from diagnosis to treatment (TDT) has. We retrospectively analyzed the impact of TDT on progression-free survival (PFS) and overall survival (OS) using patient characteristics available at diagnosis. From the databases of two large lymphoma treatment centers in Singapore, we included 581 DLBCL patients sequentially diagnosed and treated with R-CHOP (or R-EPOCH) between 2002 and 2014. All transformed lymphomas and retroviral positive cases were excluded. Patients with TDT > 7 weeks were also excluded as only a few (N=17) in our dataset were, and in real world practice would be, treated beyond this time. The effect of TDT on PFS and OS was examined in Cox regression models which included other known prognostic variables of age, extranodal (EN) sites, lactate dehydrogenase (LDH), performance status, stage, international prognostic index (IPI) risk and cell-of-origin (COO) based on Hans' algorithm. TDT was treated as a continuous variable in per week time units. As well as in a binary normal vs. high model, LDH was analyzed as a continuous variable and then categorically following the NCCN-IPI concept of a normalized LDH to provide more clinical relevance. The median age was 60 years (range, 15-88) and median follow up in surviving patients 47 months. The number of patients with TDT in week 1 = 97, week 2 = 199, week 3 = 126, week 4 = 81, week 5 = 41, week 6 = 28, week 7 = 9. The median TDT was 14 days (range, 4-49) and was significantly longer in patients with normal LDH level, stage 1-2 disease, EN ≤ 1 site, and low IPI. In univariate analysis, longer TDT was associated with poorer PFS and OS in the high LDH and stage 3-4 groups. Cox regression analysis for PFS showed that poorer performance state of ECOG ≥ 2 (P=0.029), stage 3-4 disease (P<0.001), increased LDH 1-2 fold (P=0.01) and ≥ 2-fold (P <0.001), and longer TDT (P=0.008; HR 1.144, 95% CI 1.036 - 1.263) were predictive. For OS, stage 3-4 disease (P=0.019), increase in LDH 1-2 fold (P=0.005) and ≥ 2-fold (P <0.001), and longer TDT (P=0.01, HR 1.154; 95% CI 1.035 - 1.287) were significantly associated. Considering the statistically significant interactions between LDH and disease stage and TDT, we performed Cox regression separately for patients with high (>normal) and normal LDH, and for advanced stage (3-4) and early stage (1-2) disease. We found that TDT remained a significant predictor of PFS and OS in patients with advanced stage but not early stage disease and in high LDH but not normal level LDH patients. The analysis demonstrated that delays in starting curative immunochemotherapy have detrimental effects on PFS and OS in patients with high LDH and advanced stage disease. The benefit of starting treatment earlier in DLBCL patients with higher tumor bulk, while intuitive, has not been previously demonstrated. Our findings suggest that treatment delays, whenever possible, should be minimized. Disclosures Hwang: Janssen: Honoraria, Other: Travel support; MSD: Honoraria, Other: Travel support; Celgene: Honoraria, Other: Travel support; Roche: Honoraria, Other: Travel support; Sanofi: Honoraria, Other: Travel support; Pfizer: Honoraria, Other: Travel support; BMS: Honoraria, Other: Travel support; Novartis: Honoraria, Other: Travel support.

Impact of the COVID-19 pandemic on staging at presentation of patients with invasive melanoma.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e21579-e21579
Author(s):  
Saba Shaikh ◽  
Xi Yang ◽  
Dylan Fortman ◽  
Hong Wang ◽  
Diwakar Davar ◽  
...  
Keyword(s):  
Systemic Therapy ◽  
Early Stage ◽  
Stage I ◽  
Stage Iii ◽  
Categorical Variables ◽  
Early Stage Disease ◽  
Metastatic Recurrence ◽  
Stage Disease ◽  
Significant Difference ◽  
The Impact

e21579 Background: The COVID-19 pandemic has impacted cancer care beyond the direct implications of viral infection. Delays in presentation and diagnosis may lead to more advanced disease and worse patient outcomes. We evaluated the impact of the pandemic on patients (pts) with melanoma (mel). Methods: A single-institution, retrospective comparison of pts with newly diagnosed invasive mel or metastatic recurrence prior to (pre-cohort, n = 246) and after (post-cohort, n = 246) declaration of the COVID-19 pandemic on March 11, 2020. 492 pts were evaluated between March 1, 2019 and January 12, 2021. Key variables collected included demographics, pathology, stage at diagnosis, surgical management, receipt of adjuvant or systemic therapy, and follow up. Categorical variables were compared using the two-sided Fisher’s exact test, continuous variables were compared using the two-sided Wilcoxon rank sum test, and survival endpoints were evaluated with the Kaplan-Meier method. This study was exempt from review by the IRB. Results: 200 (81.3%) pts presented with early-stage disease and 46 (18.7%) pts presented with metastatic disease in the post-cohort, compared to 209 (85%) and 37 (15%) pts in the pre-cohort, respectively. In the post-cohort there was a significant decrease in stage I pts (28.5% vs 40.7%, p = 0.006), a significant increase in stage III pts (30.5% vs 21.1%, p = 0.023), and a significant increase in pts with metastatic recurrence (7.7% vs 3.3%, p = 0.046) compared to the pre-cohort. There was also a significant increase in pts with brain metastases (BM) in the post-cohort (6.5% vs 1.6%, p = 0.010). For pts with early-stage disease, there was a significant increase in median Breslow depth (2.0 vs 1.4 mm, p = 0.047) and mitotic rate > 1 (78.1% vs 66%, p = 0.008) in the post-cohort. There were trends toward increased ulceration, lymphovascular/perineural invasion, and microsatellite presence. Pts receiving adjuvant therapy in the post-cohort were significantly more likely to receive oral targeted therapy (37.6% vs 27.5%) compared to IV immunotherapy (62.4% vs 72.5%), p = 0.034, perhaps reflecting an attempt to minimize in-person visits. There was not a significant difference between the 2 groups in the type of systemic therapy administered in the metastatic setting. Median progression-free and overall survival were not reached due to a limited number of events in each arm. Conclusions: There was a significant decrease in pts with stage I mel along with a significant increase in pts with stage III mel, metastatic recurrence, and BMs presenting to our institution during the pandemic. Findings are likely related to delays from both the patient (to avoid interaction with the healthcare system - including primary care, dermatology, and oncology) and from the system itself, with some clinics potentially evaluating pts in a limited capacity. These data reaffirm the importance of early detection and evaluation of melanoma.

scholarly journals Vulvar cancer in Botswana in women with and without HIV infection: patterns of treatment and survival outcomes

2021 ◽  
pp. ijgc-2021-002728
Author(s):  
Emily MacDuffie ◽  
Sruthi Sakamuri ◽  
Rebecca Luckett ◽  
Qiao Wang ◽  
Memory Bvochara-Nsingo ◽  
...  
Keyword(s):  
Overall Survival ◽  
Hiv Infection ◽  
Vulvar Cancer ◽  
Early Stage ◽  
Stage I ◽  
Survival Outcomes ◽  
Advanced Stage ◽  
Hiv Status ◽  
Living With Hiv ◽  
The Impact

ObjectivesVulvar cancer is a rare gynecological malignancy. However, the incidence of human papillomavirus (HPV)-associated vulvar disease is increasing, particularly in low- and middle-income countries. HIV infection is associated with an increased risk of HPV-associated vulvar cancer. We evaluated treatment patterns and survival outcomes in a cohort of vulvar cancer patients in Botswana. The primary objective of this study was to determine overall survival and the impact of treatment modality, stage, and HIV status on overall survival.MethodsWomen with vulvar cancer who presented to oncology care in Botswana from January 2015 through August 2019 were prospectively enrolled in this observational cohort study. Demographics, clinical characteristics, treatment, and survival data were collected. Factors associated with survival including age, HIV status, stage, and treatment were evaluated.ResultsOur cohort included 120 women with vulvar cancer. Median age was 42 (IQR 38–47) years. The majority of patients were living with HIV (89%, n=107) that was well-controlled on antiretroviral treatment. Among women with HIV, 54.2% (n=58) were early stage (FIGO stage I/II). In those without HIV, 46.2% (n=6) were early stage (stage I/II). Of the 95 (79%) patients who received treatment, 20.8% (n=25) received surgery, 67.5% (n=81) received radiation therapy, and 24.2% (n=29) received chemotherapy, either alone or in combination. Median follow-up time of all patients was 24.7 (IQR 14.2–39.1) months and 2- year overall survival for all patients was 74%. Multivariate analysis demonstrated improved survival for those who received surgery (HR 0.26; 95% CI 0.08 to 0.86) and poor survival was associated with advanced stage (HR 2.56; 95% CI 1.30 to 5.02). Survival was not associated with HIV status.ConclusionsThe majority of women with vulvar cancer in Botswana are young and living with HIV infection. Just under half of patients present with advanced stage, which was associated with worse survival. Improved survival was seen for those who received surgery.

Novel approaches to improve prostate cancer diagnosis and management in early-stage disease

2012 ◽  
Vol 109 ◽  
pp. 1-7 ◽  
Author(s):  
Michael Marberger ◽  
Jelle Barentsz ◽  
Mark Emberton ◽  
Jonas Hugosson ◽  
Stacy Loeb ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Cancer Diagnosis ◽  
Early Stage ◽  
Early Stage Disease ◽  
Prostate Cancer Diagnosis ◽  
Diagnosis And Management ◽  
Stage Disease ◽  
Novel Approaches ◽  
Improve Prostate Cancer

scholarly journals Surgery in Small-Cell Lung Cancer

Cancers ◽  
2021 ◽  
Vol 13 (3) ◽  
pp. 390
Author(s):  
Nicola Martucci ◽  
Alessandro Morabito ◽  
Antonello La Rocca ◽  
Giuseppe De Luca ◽  
Rossella De Cecio ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Small Cell Lung Cancer ◽  
Cell Lung Cancer ◽  
Early Stage ◽  
Small Cell ◽  
Stage I ◽  
Phase Iii ◽  
Small Cell Lung ◽  
Early Stage Disease ◽  
Stage Disease

Small-cell lung cancer (SCLC) is one of the most aggressive tumors, with a rapid growth and early metastases. Approximately 5% of SCLC patients present with early-stage disease (T1,2 N0M0): these patients have a better prognosis, with a 5-year survival up to 50%. Two randomized phase III studies conducted in the 1960s and the 1980s reported negative results with surgery in SCLC patients with early-stage disease and, thereafter, surgery has been largely discouraged. Instead, several subsequent prospective studies have demonstrated the feasibility of a multimodality approach including surgery before or after chemotherapy and followed in most studies by thoracic radiotherapy, with a 5-year survival probability of 36–63% for patients with completely resected stage I SCLC. These results were substantially confirmed by retrospective studies and by large, population-based studies, conducted in the last 40 years, showing the benefit of surgery, particularly lobectomy, in selected patients with early-stage SCLC. On these bases, the International Guidelines recommend a surgical approach in selected stage I SCLC patients, after adequate staging: in these cases, lobectomy with mediastinal lymphadenectomy is considered the standard approach. In all cases, surgery can be offered only as part of a multimodal treatment, which includes chemotherapy with or without radiotherapy and after a proper multidisciplinary evaluation.

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