Thyroid Papillary Carcinoma and Hyperthyroidism: A Case Study

Background: Concurrent thyroid cancer and hyperthyroidism is a rare finding. The frequency of this association is very variable. A rare case of papillary thyroid cancer associated with hyperthyroidism is described here. Case: A 49-year-old male presented to the authors’ outpatient clinic with complaints of a painless left-sided anterior neck swelling that had persisted for the past 8 months. He also reported weight loss for the same duration. The anterolateral swelling was non-tender, asymmetrical, mobile, and rubbery. Investigations: Biochemical analysis confirmed hyperthyroidism. Ultrasound examination of the neck showed a well-defined, solid, and cystic lesion in the left lobe and isthmus of thyroid gland. The solid portion had few specks of calcification. A radioactive thyroid scan showed increased tracer uptake in the left lobe. Papillary carcinoma of thyroid origin was discovered after fine-needle aspiration of the left anterior cervical lymph node. After preparation, a total thyroidectomy was done. Examination of histopathology confirmed papillary thyroid carcinoma. Treatment: Following radioactive thyroid ablation, the patient was started on suppressive doses of thyroxine daily. Conclusion: Although thyroid cancer with hyperthyroidism is a rare finding, it should not be disregarded. To avoid missing this unusual yet uncommon discovery, a detailed history and physical examination should be performed, as well as all required investigations.

Emerging Role of Aurora A in Radioresistance: A Comprehensive Review

Radiotherapy is one of the most conventional modes of treatment in several cancers. Failure of radiotherapy followed by acquisition of radioresistance is one of the emerging challenges faced by clinical experts. Unusual expression and functional implications of several molecules are observed to facilitate radioresistance. Aurora A, a member of the Aurora kinase (serine/threonine kinase) family, is one such molecule that shows significantly altered expression as well as non-canonical functional crosstalk with other associated factors (cell cycle regulators, signaling molecules, stemness markers, etc.) to favour the adaptations for the acquirement of radioresistance. These mechanisms include progression of cell cycle, stimulatory activation of factors by phosphorylation for enhancing the chance of cellular survivability, and prevention of apoptosis. This review article summarises how Aurora A is responsible for radioresistance in cancer and why this kinase should be considered a negative biomarker of radiosensitivity. This review discloses a wider opportunity in the field of research to find the mechanistic key regulatory pathway of Aurora A, which can be a potential target for enhancing the efficiency of treatment. Further investigations are required to explore the potential of Aurora A inhibitors as reliable radiosensitisers.

Management of Lower Limb Soft Tissue Sarcomas with Major Neurovascular Involvement: Current and Future Perspectives

Lower limb soft tissue sarcomas are a group of rare mesenchymal tumours that may grow in close anatomical proximity to major neurovascular structures, leading to significant oncological and surgical challenges for treating physicians. This article reviews the current literature on the multidisciplinary approach of treating lower limb soft tissue sarcomas with neurovascular involvement and describes the increasing shift towards limb-sparing surgeries, with an emphasis on improved functional outcomes based on a multimodal treatment approach. In addition to identifying the histological subtype of the tumour, classifying the neurovascular involvement precisely is key in planning the appropriate treatment. Existing classification systems for both vascular and neural involvement are discussed, and a combined neurovascular classification is proposed together with a general treatment algorithm.

Perspectives on Hepatic Metastases and the Minimally Invasive Approach to Resection

Surgical resection is the most effective treatment approach in colorectal liver metastases. The improved survival in Stage IV colorectal cancer is associated with a better diagnosis and evaluation, proper decision-making, improved chemotherapy, and the adoption of parenchymal-sparing hepatic resections. Liver surgery was one of the last frontiers reached by minimally invasive surgery. Surgical techniques and specialised equipment evolved to overcome the technical limitations, making laparoscopic liver resections safe and feasible. The aetiology and pathophysiology of hepatic metastases are discussed along with the rationale for and efficacy of minimally invasive surgery for colorectal liver metastases. Improved imaging techniques, identification of genomic markers, advances in chemotherapy, and personalised therapy will further improve the outcome of minimally invasive surgery in the management of Stage IV colorectal cancer.

Evaluation of Treatment Outcome and Acute Toxicity in Patients Undergoing Adjuvant Therapy in Ductal Carcinoma Pancreas: A Prospective Observational Study

Ductal adenocarcinoma of the pancreas is one of the commonly diagnosed cancers and is a leading cause of cancer mortality in the population. The prognosis of patients even after undergoing a complete resection is generally poor, with a median survival of 13–20 months and a 3-year survival of 30%. Therefore, adjuvant therapies including adjuvant chemoradiation and adjuvant chemotherapy are given in an effort to improve survival. In the authors’ centre, all patients undergoing resection are given adjuvant chemoradiation followed by adjuvant chemotherapy. This study was conducted to evaluate the acute toxicity and treatment outcome (patterns of failure, overall and disease-free survival) of patients undergoing adjuvant therapy in resected carcinoma pancreas. Adjuvant chemoradiation was well tolerated by most patients with resected carcinoma pancreas and all patients completed chemoradiation. Adjuvant chemotherapy was associated with high haematological toxicity, similar to previously published literature. However, treatment interruptions were higher and only 77% patients completed adjuvant chemotherapy. The adjuvant gemcitabine, given on Days 1, 8, and 15, for a 4-weekly schedule was poorly tolerated by the authors’ patient population and there were only fewer interruptions in patients who were switched to the 3-weekly schedule. Inclusion of a greater number of patients and longer follow-up of this study is required to clearly assess the patterns of failure and survival outcomes.

More than FOLFOX and FOLFIRI: The Management of Metastatic Colorectal Cancer in the Era of Precision Oncology

Metastatic colorectal cancer (mCRC) is a markedly heterogeneous disease, which portends a poor prognosis, with an estimated 5-year overall survival rate of approximately 15%. The standard of care of systemic therapy remains fluoropyrimidine-based chemotherapy, with modest results, despite improvements with the combination with anti-angiogenics and anti-epidermal growth factor receptor therapy. Significant advances in cancer therapy have been observed in the past two decades. The enhanced appreciation of molecular biology in oncology has allowed for the identification of specific molecular subtypes and novel therapeutic targets. Nevertheless, meaningful precision-based advancements in the therapeutic options for mCRC have been challenging and slow to realisation. Comprehensive molecular profiling and circulating tumour DNA highlight a heterogeneous disease at the genomic, epigenomic, and transcriptomic levels, and with a low frequency of actionable alterations. In the present review, the authors describe the current and emerging predictive biomarkers in mCRC, as well as present landmark clinical trials that have allowed for evolving precision in the therapeutic management. The understanding of the benefit of immune checkpoint inhibitors in patients with high microsatellite instability cancer and in those with POLE mutations or high tumour mutational burden, the combination of BRAF with epidermal growth factor receptor inhibition in BRAF V600-mutated patients, the use of allele-specific KRAS G12C inhibitors, the promising findings of dual anti-HER2 therapy in HER2-positive mCRC, and the possibility to offer targeted therapy for patients harbouring gene fusions NTRK/ALK/ROS1 have ushered in a new era of precision oncology for mCRC, providing personalised treatments and sustaining hope for patients affected by this challenging disease.

Balancing Risk of Thromboembolism and Bleeding in Patients with Cancer: Selecting Anticoagulant Therapy Based on Recent Clinical Trials

Patients with cancer may experience venous thromboembolism (VTE), leading to various medical complications or death, more often than the population without cancer. Moreover, patients with cancer usually experience both higher rates of recurrent VTE and bleeding. For the past decade, low-molecular-weight heparin (LMWH) has been considered a standard therapy for VTE related to cancer; however, daily injections of LMWH have augmented the burden of neoplastic disease and decreased adherence to therapy in some patients. At present, direct oral anticoagulants (DOAC) such as factor Xa inhibitors (e.g., rivaroxaban, edoxaban, and apixaban) have been recommended as a new treatment modality, mostly because of their convenient use (i.e., the oral route of delivery) for the patient population with cancer. Notably, large recent randomised controlled trials that have compared DOACs with LMWH in patients with malignancies have revealed that DOACs represent a valuable alternative to LMWH for the therapy of VTE related to cancer. Despite their unique advantages, the DOACs may not be appropriate for some groups of patients with cancer due to their elevated risk of bleeding, among other factors. This mini-review presents the main findings from some recent randomised controlled trials, comparing the use of DOACs and LMWH for the management of VTE associated with malignancy. It highlights the efficacy, safety, and various other considerations of treatment and prophylaxis of VTE depending on the individual patient context. It provides current guidance on the selection of the optimal anticoagulant for comprehensive and personalised patient care.

Phosphate and Oxysterols May Mediate an Inverse Relationship Between Atherosclerosis and Cancer

The peer-reviewed literature has reported an inverse relationship between atherosclerosis and cancer for almost 100 years, but no causative mechanism has been established to explain this puzzling relationship. More recent research has reported an association between tumourigenesis and phosphate toxicity from dysregulated phosphate metabolism, and an association has also been reported between atherosclerosis and cholesterol oxidation products or oxysterols. The present review article synthesises these research findings and proposes that an inverse relationship between the associated risk of cancer and atherosclerosis may be mediated by tumourigenic and atherogenic dietary patterns containing inverse proportions of dietary phosphate and oxysterols. Low-fat animal-based foods generally have reduced cholesterol and oxysterol levels and relatively higher protein and phosphate levels, and dietary patterns containing these foods are associated with reduced atherosclerosis risk and increased cancer risk. By comparison, full-fat animal-based foods are higher in cholesterol and oxysterols and relatively lower in protein and phosphate, and dietary patterns containing these foods are associated with increased atherosclerosis risk and reduced cancer risk. Fruits, vegetables, and plant-based fats generally have lower phosphate levels and no cholesterol, and dietary patterns associated with increased amounts of these foods, such as the Mediterranean diet, reduce risk for both cancer and cardiovascular disease.